sildenafil for the treatment of lymphatic malformations.

April 9, 2014 by  
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Lymphatic Malformations can be very challenging for the clinician to treat.  Interventions include sclerotherapy and surgery are invasive and may result in complications and recurrence of the lesion.   A new study published in the Journal of the American Academy of Dermatology 2014 March 20 pii: S0190-9622(14)0119-0 examines  sildenafil generic for viagra to treat lymphatic malformations.

Patients were placed on 20 weeks of oral sildenafil, LM were assessed for volum and symptoms.  Sever male children and 3 females were observed; ages 13-85 months.  There was a therapeutic response of softening and compressiblity in all patients.  Adverse events were minimal.  A larger randomized controlled study is needed to better verify these results however; it seems sildenafil may reduce lymphatic malformation volume and symptoms in some patients.


Karla Hall


J Am Acad Dermatol. 2014 Mar 20. pii: S0190-9622(14)01119-0. doi: 10.1016/j.jaad.2014.02.005. [Epub ahead of print]

An open-label study to evaluate sildenafil for the treatment of lymphatic malformations.

Danial C1, Tichy AL1, Tariq U2, Swetman GL1, Khuu P1, Leung TH1, Benjamin L1, Teng J1, Vasanawala SS2, Lane AT3.

Author information

  • 1Department of Dermatology, Lucile Packard Children’s Hospital at the Stanford University School of Medicine, Palo Alto.
  • 2Department of Radiology, Stanford University School of Medicine, Stanford.
  • 3Department of Dermatology, Lucile Packard Children’s Hospital at the Stanford University School of Medicine, Palo Alto. Electronic address:

Summary on Propranolol

April 7, 2014 by  
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Just finished reading 6 Abstracts on the use of Propranolol in the management of Infantile Hemangioma.  All of the information came  from presentations at the 2014 ISSVA meeting in Melbourne, Australia last week.    A summary is below.  Much of the information is just now being published in the latest Medical Journals so it truly is the latest medical information on the subject.

Propranolol is a widely prescribed medication classified as a  beta-blocker used for the treatment of infantile hemangioma.  Since 2007 it has been used off-label because there has not been an approved formulation of propranolol, specific for infants and the treatment of infantile hemangioma.  Several institutions here in the USA and Europe have taken part in a 2+ year study assessing the safety of propranolol in infants.  As a result an oral formulation will be available here in the USA in June 2014 under the brand name Hemangeol.  (Pierre Fabre Pharmaceuticals USA will be manufacturing the medication)  The studies have not only produced a new brand name of propranolol here in the USA but it has produced data on the safety and efficacy of this medication in the treatment of infantile hemangioma.

Oral Propranolol has a favorable risk profile in the pediatric population studied.  In one study of  460 infants the IH improved in 88% of the patients treated with no unexpected safety concerns.   This same group reported that patients tolerated the medication with mild  or moderate side effects.  The only contraindication being noted is bronchial reactivity.  (1,2)

Another study examined the impact of propranolol on pediatric growth and human growth hormone levels in infants.  No impact was found. (3)

A group from Russia studied the effects of propranolol on the cardiovascular system with and without preexisting heart problems.  154 infants with IH were prescribed propranolol and cardiological evaluation with EKG, ECHO, holter monitoring and blood pressure was observed for more then 9 months.  Only a small percentage of adverse events were noted.  This group recommends monitoring children at risk for cardiac complications during use of propranolol.  A similar study out of Oregon concluded that routine ECG monitoring for patients prior to propranolol use is not necessary and a more purposed driven strategy is a better approach.  (4,5)

272 Hemangioma Patients were evaluated for developmental psychomotor skills.  No delays or effects on psychomotor development was found. (6)


In my review of this information propranolol appears to be safe to use in most infants and children presenting with infantile hemangioma.  Patients should be monitored during treatment and physicians should be awear of the indications for concern.  More studies are on going.


1.Christine Leaute-Labreze, Ilona Frieden, Pierre Vabres, Sorilla Prey, Jean-Jacques Voisard, Propranolol in IH: Results from an international randomized placebo controlled study.

2.Sorilla Prey, Christinen Leute-Labreze, Ilona Frieden, Allain Delarue, Jean Jacquez Voisard, Safety of oral propranolol for the treatment of IH: 2 years results of a controlled multicenter trial

3.Rachel Giese, Mario Cleves, Jessica Boswell, James Suen, Gresham Richter, Propranolol for Treatment of IH: Efficacy and Effect on Growth and Development

4. Margarita Timofeeva and Natalia Katlukova, Cardiovascular Complications of Propranolol Treatment for IH

5.Kevin Yarbrough, Alfan Krol, Julianne Mann, Sabra Leitenberger, Carol MacArthur, Is Routine ECG necessary prior to initiation of propranolol for treatment of IH

6.  Andre Moyakine, Denise Hermans, Joris Fuijkschot, Carine van der Vleuten, Development Milestone: no negative effects detected upon psychomotor development



As these articles get published we will update the references and citations.

Karla Hall

April 2014




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April 5, 2014 by  
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Blog Rules and Use

September 23, 2010 by  
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NOVA operates a public blog and message forums for purpose of the exchange of information. The blog and forums can be viewed by all. The blog and forums are not intended to be used as a replacement for professional medical information and advice. NOVA encourages all users to seek the medical advice from a physician experienced in the diagnosis and treatment of vascular anomalies.

The NOVA Message Blog and NOVA Message Forums are administered by the NOVA Board of Directors and are moderated by Karla Hall, Executive Director of NOVA. There are no conflicts of interest to report for our moderator.

All users must register with a valid user name and email address. User Names do not have to be real names. Users may elect to keep email and identity private from other users. Users may delete or modify their own postings/comments at any time. In accordance with the NOVA confidentiality policy ( ), NOVA Administrators, Moderators or representatives will maintain patient confidentiality of all users. We will not publish identifiable information unless written authorization is given. NOVA can not maintain confidentiality of users if users post identifiable information in their own postings. For confidential correspondence with NOVA please email us at

When posting information that is not based on personal experience, please provide references/citations. (journal sources, web sites or other sources of information)

Users to the Blog and Forms must to the best of their ability post true and accurate information. We request all users to refrain from “doctor bashing” on our forms.

All postings containing links, banners, information about products and services will be reviewed by the moderator for accuracy and content. Only products or services related to health and vascular anomalies will be allowed. Any posting about a service or product must receive prior permission from the NOVA Board of Directors. Postings that did not receive prior approval will be deleted without notice.

Comments on the Blog will be approved by the moderator and then allowed to be posted. The moderator views daily. Questions posted on the blog or the forums of a medical nature will be forwarded to the NOVA Medical Director or NOVA Medical Advisors. Replies will include the name and credentials of responder. Any medical professional that is a blog or forum user must clearly identify themselves and provide credentials. All blog and forum users must behave with respect and honesty. No profanity or obscenity is allowed. Biological terminology in a medical context will not be considered profane or obscene. NO solicitation is allowed. Violators will be warned via email one time only. Further abuse will result in a banning form use. All banning will be initiated by the Moderator and approved by the NOVA Board of Directors. Blog comments of a solicitous nature will be denied permission to post.

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