PROPRANOLOL FOR MANAGEMENT OF INFANTILE HEMANGIOMAS

Purpose: Infantile hemangiomas (IHs) are the most common developmental vascular abnormalities of childhood. These benign lesions undergo a rapid growth phase during the first few months, followed by spontaneous involution, in most cases, without any major subsequent complications. However, a minority of IHs can cause significant functional impairment or disfigurement, indicating the need for therapy. Systemic corticosteroids were initially considered the first-line treatment. Recently, propranolol was incidentally discovered to demonstrate increased efficacy in promoting the reduction of hemangiomas, in addition to fewer side effects compared to steroids. This case report documents the effects of propranolol therapy on the management of a patient with an extensive right-sided facial hemangioma affecting the periorbital and nasal regions. Methods: Patient was 3 months of age when first seen for consultation for a large right-sided facial hemangioma. He was managed with an oral suspension of Propranolol 20mg/5 ml. On the first two days of treatment, the patient was given one daily dose of .5mg/kg, and on days 3-7, he was given .5mg/kg twice a day. At one week, the dose was increased to 1 mg/kg twice a day. A follow up was conducted at two weeks, then once every month. The response to propranolol therapy was documented using clinical observation and photographs. Results: Clinical improvement of the IH was noted 10 days after initiating propranolol therapy. Over a 5 month course of treatment, the lesion softened and flattened in appearance, as well as changed in color from red to deep purple to a more soft purple with flesh toned areas. An impressive regression in size of the lesion was noted, enabling patient to open and close the right eye without difficulty. Conclusions: Propranolol therapy has been documented for it's efficacy and safety in the management of IHs that pose a high risk for disfiguring complications. This case report confirms the results of previous studies. The patient's hemangioma demonstrated drastic improvement in response to propranolol therapy in terms of both appearance, as well as reduction in size of the lesion, contributing to an improved quality of life.