Propranolol Reduces Size and Blood Vessel Density of Infantile Hemangiomas

Can the effect of propranolol on infantile hemangiomas be quantified?

Background: The utilization of propranolol for the treatment of infantile hemangiomas is efficacious and is considered the first-line treatment. Many questions still remain regarding propranolol, including the mechanism of action, the specific clinical effects, the duration of treatment and the reason(s) for treatment failure in some situations. The largest hurdle in understanding the effect of propranolol or any treatment on infantile hemangiomas has been the lack of an objective measure to quantify changes.

Study design: Case series with chart review.

Setting: Tertiary pediatric hospital.

Synopsis: Nineteen patients were included in this study, which used ultrasound techniques to characterize changes in infantile hemangiomas. Gray-scale and color Doppler ultrasound imaging was performed prior to treatment and at least four weeks following the initiation of treatment. The mean lesion area change with treatment was 13.0 cm2, the mean volume change was 10.3 cm3 and the mean vessel density change was 4.4 vessels per cm2. Changes measured using ultrasound were greater than those measured clinically. The obvious weaknesses of this study are its retrospective nature and small cohort size.

Bottom line: This study illustrates an objective method by which to characterize changes in infantile hemangioma. Such methodology is essential not only to characterize the course of hemangiomas on different locations of the body but also to determine the efficacy of intervention.

Citation: Bingham MM, Saltzman B, Vo NJ, Perkins JA. Propranolol reduces infantile hemangioma volume and vessel density. Otolaryngol Head Neck Surg. 2012;147(2):338-344.