Hemangioma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]Amandeep Singh M.D.[3]

Overview

The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically.

Medical Therapy

  • Medical and surgical options are available for the treatment of “problematic” hemangiomas.[1][2]
  • Medical management includes one or more systemic therapies.
  • For massive and life-threatening disease:[1]
  • These agents have also been used for:[1]
    • Multifocal disease
    • Visceral involvement
    • Segmental distribution
    • Airway obstruction
    • Periorbital lesions

Propranolol

  • A paradigm shift has occurred regarding the treatment of hemangiomas over the past few years.[1]
  • Propranolol, a nonselective β-adrenergic antagonist, was serendipitous discovered to cause regression of proliferating hemangiomas in newborns receiving treatment for cardiovascular disease.
  • Numerous studies demonstrating the success of propranolol for shrinking hemangiomas
  • Over ninety percent of patients have dramatic reduction in the size of their hemangiomas as early as 1-2 weeks following the first dose of propranolol.
  • Dosing for propranolol in treating hemangiomas is recommended to be 2-3 mg/kg separated into two or three-times-a-day regimens.
  • These doses are dramatically below the concentration employed for cardiovascular conditions in children.[1]

Pediatric/Infantile hemangioma in proliferative phase:

Beyond proliferative phase

  • Oral regimen
    • Preferred regimen (1): Propranolol 1.5-3 mg/kg/day PO for 8 months.[3]

References

  1. 1.0 1.1 1.2 1.3 1.4 Richter, Gresham T.; Friedman, Adva B. (2012). "Hemangiomas and Vascular Malformations: Current Theory and Management". International Journal of Pediatrics. 2012: 1–10. doi:10.1155/2012/645678. ISSN 1687-9740.
  2. Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#
  3. Zvulunov A, McCuaig C, Frieden IJ, Mancini AJ, Puttgen KB, Dohil M, Fischer G, Powell J, Cohen B, Ben Amitai D (2011). "Oral propranolol therapy for infantile hemangiomas beyond the proliferation phase: a multicenter retrospective study". Pediatr Dermatol. 28 (2): 94–8. doi:10.1111/j.1525-1470.2010.01379.x. PMID 21362031.

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