Br J Dermatol. 2010 May 8 Storch CH, Hoeger PH
Abstract: Infantile haemangiomas (IH) are the most common benign tumours of infancy. Although most IH are innocuous and 85-90% regress spontaneously, some may become life- or function-threatening and require immediate treatment. Previous standard therapeutic options include physical measures (laser surgery, cryosurgery) and systemic corticosteroids, in severe cases also vincristine, alpha-interferon or cyclophosphamide, all bearing the risk of serious side effects. Oral propranolol is a very recent therapeutic option for complicated IH with impressive efficacy and generally good tolerance. The effects of propranolol on IH were discovered by chance, and very little is known about its mechanisms of action in IH. Here we present a summary of current knowledge of how propranolol interferes with endothelial cells, vascular tone, angiogenesis and apoptosis. Early, intermediate and long-term effects of propranolol on IH can be attributed to three different pharmacological targets: Early effects (brightening of the haemangioma surface within 1-3 days after start of therapy) are attributable to vasoconstriction due to decreased release of NO. Intermediate effects are due to the blocking of pro-angiogenic signals (VEGF, bFGF, MMP 2/9) and result in growth arrest. Long-term effects of propranolol are characterized by induction of apoptosis in proliferating endothelial cells, and result in tumour regression.
PMID: 20456345 [PubMed - as supplied by publisher]
Clin Experiment Ophthalmol. 2010 Jun 11. [Epub ahead of print]
Propranolol in the management of periorbital infantile haemangioma.
Cheng JF, Gole GA, Sullivan TJ.
Royal Children's Hospital, Herston Road, Brisbane, Queensland, 4029. Australia.
Abstract
ABSTRACT Background: Infantile haemangiomas are the commonest tumours of the orbit in children. Treatment is usually expectant, unless they are visually threatening. While steroids, other pharmacological and surgical treatment modalities have their place, there are risks involved. A previous case series reported the successful use of propranolol for infantile haemangioma. The safety and efficacy of propranolol in the treatment of periorbital haemangiomawas reviewed in a serious of our patients. Methods: We performed a retrospective review of patients seen by two ophthalmologists (TJS and GAG), collecting data on colour, size of lesion, duration of treatment and side effects of treatment. Our main outcome measures were color and size of infantile haemangioma before and after treatment, the change in astigmatism of our patients and the incidence of complications from propranolol. Results: We reviewed 10 patients with infantile haemangioma. They were treated with propranolol oral syrup 2mg/kg/day in divided doses for a mean duration of 32.8 weeks (range, 12 weeks - 42 weeks). All our patients had a reduction in colour and size of the lesions. The mean lesion size decreased from 756.7mm(2) to 543.2mm(2) post-treatment (P = 0.075). Five patients had significant astigmatism and 60% had successful reduction of astigmatism after treatment. None of our patients suffered significant side-effects of propranolol. Conclusion: Propranolol appears to be a safe and effective treatment in the management of infantile haemangioma.
PMID: 20553300 [PubMed - as supplied by publisher]
Clin Experiment Ophthalmol. 2010 May 10. [Epub ahead of print]
Successful treatment of infantile haemangiomas of the orbit with propranolol.
Li YC, McCahon E, Rowe NA, Martin PA, Wilcsek GA, Martin FJ.
Sydney Eye Hospital, Sydney, Australia.
Abstract
ABSTRACT Background: Propranolol is a novel therapeutic agent in the treatment of cutaneous infantile haemangiomas. We assessed the effect of propranolol therapy in infantile haemangiomas of the orbit. Methods: A case series of four patients with orbital infantile haemangiomas were referred for management in our tertiary referral hospitals. Two of the patients had inadequate responses to prior corticosteroid therapy. One of the patients was commenced on propranolol at two and half years of age when the lesion was not in the proliferative phase. This represented the first case report of propranolol treatment for infantile haemangioma outside infancy. The other three children were in their infancy when propranolol was commenced. The patients were treated with oral propranolol. Results: All patients had significant improvement in their physical appearance, ocular examination findings and size of their lesions on radiological evaluation. No side effects of propranolol treatment were observed. Conclusions: Propranolol is a promising treatment against infantile haemangiomas in the orbit, not only in infants but also in an older child with a stable lesion.
PMID: 20491798 [PubMed - as supplied by publisher]