Propranolol as first-line treatment of head and neck hemangiomas

January 01, 0001

Propranolol as first-line treatment of head and neck hemangiomas

These French and Canadian authors report the results of a case series (n=39) of propranolol as first-line treatment of head and neck hemangiomas in children and to present an optimized protocol for treating hemangiomas. Data were obtained by chart review.

They found: "Propranolol was the sole treatment in 60% of patients and was started at a mean age of 4.1 months (age range, 1-11 months) for early interventions among 33 of 39 patients. Propranolol therapy resulted in lightening and reduction of hemangiomas at 37 of 39 locations within 2 days to 2 weeks. One subglottic hemangioma and 1 nasal tip hemangioma did not respond or showed only a partial response; in these patients, propranolol therapy was delayed and followed other treatment failures. After successful therapeutic regression, 6 recurrences occurred; when reintroduced, propranolol was again effective. Recurrences were avoided by prolonged treatment. Twenty-six hemangiomas occurring at locations for which corticosteroid treatment previously would not have been initiated (nose, lips, and parotid area) unless a complication had occurred were treated with propranolol and were rapidly controlled. The mean duration of propranolol therapy was 8.5 months. No instances of beta-blocker discontinuation because of complications occurred, but propranolol was substituted by acebutolol in 5 patients because of trouble sleeping."

The authors concluded: "Propranolol is an effective treatment of head and neck infantile hemangiomas, especially when started early within the rapid growth phase, and is first-line treatment of orbit and larynx hemangiomas. The efficacy and tolerability of propranolol led us to treat some hemangiomas in patients whom we previously would have observed rather than subject to corticosteroid therapy. Relapse was avoided if treatment was prolonged after theoretical involution (age 12 months). Questions remain about optimal dosing and age at treatment cessation."

Next step should be a randomized controlled trial.

For the full abstract, click here.

Arch Otolaryngol Head Neck Surg 137(5):471-478, May 2011
© 2011 to the American Medical Association
Propranolol as First-line Treatment of Head and Neck Hemangiomas. Carine Fuchsmann, Marie-Claude Quintal, Chantal Giguere, et al. Correspondence to Dr. Fuchsmann: [email protected]

Category: K. Circulatory. Keywords: hemangiomas, children, head and neck, propranolol, retrospective case series, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 31 May 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.