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07-09-2011 | General practice | Article

Early propanolol therapy effective in infantile hemangioma patients


Free abstract

MedWire News: Early use of the beta blocker propanolol reduces the size of hemangiomas that occur around the eyes of children, US researchers suggest.

The negative effect of these vascular growths on the vision of patients is also reduced by use of the drug, they add.

"Treatment with oral propanolol produced a rapid reduction in the size of all hemangiomas, with parents reporting softening and lighter coloration within days," explain Tara Missoi, from the University of Missouri in Columbia, and team.

In the study, involving 19 periocular hemangiomas from 17 children who had a median age of 4.5 months, oral propanolol was administered to each patient for a median of 6.8 months.

The starting dosage was 0.5 mg/kg per day for 1 week, then 1 mg/kg per day for the following week, and then 2 mg/kg per day for the remaining duration of treatment.

Of note, the hemangiomas were located on the upper eyelid (n=8), lower eyelid (n=4), medial canthus (n=3), glabella (n=2), or in the orbits (n=20) of the children's eyes.

At the end of treatment, a median 61% reduction in original hemangioma surface area was noted.

Missoi and colleagues highlight that two patients experienced re-enlargement of their hemangioma on treatment cessation. However, the size increase was not large enough to require additional treatment.

Visual testing at baseline revealed amblyopia in seven patients, four of which had an astigmatic difference of at least 1.50 diopters. By the end of treatment, the latter patients experienced a median 33% reduction in astigmatism - an improvement of 0.66 diopters.

As reported in the Archives of Ophthalmology, seven patients in the cohort received corticosteroid therapy prior to enrollment in the study, but failed to respond to this conventional treatment.

This, say the researchers, suggests that propanolol may be an effective alternative to traditional steroid therapy in hemangioma patients.

"Our success may be due to the highly favorable response to propanolol and treatment before the secondary effects of excess skin and amblyopia developed," explain Missoi and team.

They highlight that the small study size prevents a definite conclusion from being reached about the efficacy of propanolol therapy in hemangioma management.

Nonetheless, Missoi and colleagues say that their findings provide important evidence that this treatment strategy may be "effective in treating and preventing loss of visual acuity associated with periocular infantile hemangiomas."

By Lauretta Ihonor

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