Further evidence for dermatologic benefits of propanolol

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By Helen Albert

Results from a Greek study give further support to the use of propanolol as a first-line treatment for problematic infantile hemangiomas.

Anastasia Georgountzou and colleagues from the University of Athens report 3-year findings from their clinic showing excellent results with propanolol (2 mg/kg per day) with most (25 out of 28 patients; 87.5%) lesions regressing completely with no relapses.

In three patients who had relapses, two had complete involution after a second course of propanolol and one after a third course of propanolol.

Clinical response and tolerance of propanolol was monitored every month, but side effects were minimal, with hypotension observed in just four patients. However, these cases were transient and were controlled by adjusting the dose of propanolol or were self-resolving.

Twenty-four of the children completed their treatment after a mean period of 7.56 months, two children are still undergoing treatment with satisfactory results to date, and two children did not attend a follow-up appointment.

Beneficial effects on color and growth of the hemangiomas were observed within 1 month of treatment in all cases, but the researchers say that "the optimal duration of the treatment remains to be defined by long-term observation."

The results of this study support those of other studies carried out since the "serendipitous discovery of propanolol's inhibitory effects during the proliferative phase of the hemangioma cycle in 2008," say Georgountzou et al.

Although the group was fairly small, the results add to the number of patients with severe infantile hemangiomas treated exclusively with propanolol with long-term follow-up data.

"Before the propranolol era, children with problematic infantile hemangiomas would have received treatments requiring either a more invasive way of administration or resulting in more frequent or severe side effects," explain the authors in Acta Paediatrica.

"This meant more intensive follow-up to monitor treatment toxicity and thus more consultations and hospitalization days. It is our impression, in comparison to the past, that patients' parents are more enthusiastic towards this new treatment protocol, and therefore, better compliance is achieved."

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