Propranolol vs corticosteroids for infantile hemangiomas: A multicenter retrospective analysis

Cynthia J. Price, Carol Lattouf, Bertha Baum, Michael McLeod, Lawrence A Schachner, Ana M. Duarte, Elizabeth Alvarez Connelly

Research output: Contribution to journalArticle

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Abstract

Objective: To determine whether propranolol therapy is safe and effective and superior to oral corticosteroids for treating infantile hemangiomas (IHs). Design: Multicenter retrospective chart review. Setting: University of Miami and Miami Children's Hospital, Miami, Florida. Patients: The study included 110 patients with IHs. Main Outcome Measures: The percentage of clearance was quantified by documented serial global photography and clinical examinations (length, height, and width) to segregate patients into 2 groups: patients who had clearance of 75% or more and patients who had less than 75% clearance. Results: The mean duration of treatmentwas 7.9 months for propranolol and 5.2 months for oral corticosteroids. Fifty-six of 68 patients (82%) who were receiving propranolol achieved clearance of 75% or more compared with 12 of 42 patients (29%) who were receiving oral corticosteroids (P<.01). Adverse effects were minimal in the propranolol group: 1 patient had hypoglycemia and 2 patients had a nonspecifice skin eruption that was not associated with propranolol therapy. All 42 patients in the corticosteroid group had 1 or more adverse effects (P≲λτ∀.01). Relapse after discontinuation of propranolol therapy occurred in 2 of the 68 patients; however, both patients responded to propranolol therapy on reinitiation of treatment. Surgical referrals after treatment were required in 8 patients (12%) in the propranolol group and 12 patients (29%) in the oral corticosteroid group (P≲λτ∀.01). Conclusions: Propranolol therapy was more clinically effective and more cost-effective than oral corticosteroids in treating IHs. It also resulted in fewer surgical interventions and demonstrated better tolerance, with minimal adverse effects, compared with oral corticosteroids. Therefore, propranolol should be considered a first-line agent given its safety and efficacy in the treatment of IHs.

Original languageEnglish
Pages (from-to)1371-1376
Number of pages6
JournalArchives of Dermatology
Volume147
Issue number12
DOIs
StatePublished - Dec 1 2011

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Hemangioma
Propranolol
Adrenal Cortex Hormones
Therapeutics
Photography
Hypoglycemia
Referral and Consultation

ASJC Scopus subject areas

  • Dermatology

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Propranolol vs corticosteroids for infantile hemangiomas : A multicenter retrospective analysis. / Price, Cynthia J.; Lattouf, Carol; Baum, Bertha; McLeod, Michael; Schachner, Lawrence A; Duarte, Ana M.; Connelly, Elizabeth Alvarez.

In: Archives of Dermatology, Vol. 147, No. 12, 01.12.2011, p. 1371-1376.

Research output: Contribution to journalArticle

Price, Cynthia J. ; Lattouf, Carol ; Baum, Bertha ; McLeod, Michael ; Schachner, Lawrence A ; Duarte, Ana M. ; Connelly, Elizabeth Alvarez. / Propranolol vs corticosteroids for infantile hemangiomas : A multicenter retrospective analysis. In: Archives of Dermatology. 2011 ; Vol. 147, No. 12. pp. 1371-1376.
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abstract = "Objective: To determine whether propranolol therapy is safe and effective and superior to oral corticosteroids for treating infantile hemangiomas (IHs). Design: Multicenter retrospective chart review. Setting: University of Miami and Miami Children's Hospital, Miami, Florida. Patients: The study included 110 patients with IHs. Main Outcome Measures: The percentage of clearance was quantified by documented serial global photography and clinical examinations (length, height, and width) to segregate patients into 2 groups: patients who had clearance of 75{\%} or more and patients who had less than 75{\%} clearance. Results: The mean duration of treatmentwas 7.9 months for propranolol and 5.2 months for oral corticosteroids. Fifty-six of 68 patients (82{\%}) who were receiving propranolol achieved clearance of 75{\%} or more compared with 12 of 42 patients (29{\%}) who were receiving oral corticosteroids (P<.01). Adverse effects were minimal in the propranolol group: 1 patient had hypoglycemia and 2 patients had a nonspecifice skin eruption that was not associated with propranolol therapy. All 42 patients in the corticosteroid group had 1 or more adverse effects (P≲λτ∀.01). Relapse after discontinuation of propranolol therapy occurred in 2 of the 68 patients; however, both patients responded to propranolol therapy on reinitiation of treatment. Surgical referrals after treatment were required in 8 patients (12{\%}) in the propranolol group and 12 patients (29{\%}) in the oral corticosteroid group (P≲λτ∀.01). Conclusions: Propranolol therapy was more clinically effective and more cost-effective than oral corticosteroids in treating IHs. It also resulted in fewer surgical interventions and demonstrated better tolerance, with minimal adverse effects, compared with oral corticosteroids. Therefore, propranolol should be considered a first-line agent given its safety and efficacy in the treatment of IHs.",
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