Propranolol has replaced steroids as the first line medical treatment for infantile hemangiomas. Propranolol is a beta-receptor blocker – it’s effects in general are to decrease heart rate, decrease blood pressure, relieve anxiety and various other uses. However, for infantile hemangiomas it has been found to decrease the rate of proliferation and increase the rate of involution. The doses at which propranolol is used for hemangiomas is much lower than for other conditions – therefore the side effects are extremely rare. Propranolol is also available as Hemangeol (made by Pierre-Fabre Pharmaceuticals). It is the only FDA approved version of propranolol for the treatment of infants with infantile hemangioma. It is formulated specifically for this use.
Oral or systemic steroid hemangioma therapy is used for life-threatening lesions and those that do not respond to propranolol.
Carefully Monitored Treatment is Necessary
Lesions are rarely life-threatening. These are always treated with steroids and other medicines. The use of this medication is carefully monitored due to side effects. They are very effective in slowing down the proliferation and buying time for other options, however.
There is evidence that shows that systemic steroids used for hemangioma therapy and treatment of problematic lesions have short term side effects but no long term complications. These medications must be used at an appropriate dosage for a lengthy period while the child is monitored by a specialist and pediatrician.
Patients must be carefully weaned off of the steroids and sometimes are restarted at a lower dosage if the hemangioma rebounds‚ or begins to grow again.
The closer the patient is to 12 months of age, the less likely the lesion is to continue growing. Intra-lesional injections of steroids, in our opinion, are of benefit in a limited number of cases. The typical lesion which will respond to steroid injection therapy is small, circumscribed and deep. Traditionally, lesions around the eye have been treated with these injections. It is our opinion that surgery is often a better option. In any case, the injections must be repeated several times to see an effect.
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