LONDON - The combined use of propranolol and laser therapy has positive, additive effects on infantile hemangiomas, according to the results of a prospective, observational study.
While the beta-blocker appears to stop proliferation, laser therapy seems to induce the early shrinkage of these common childhood benign vascular tumors.
This offers a new option for treating infants with problematic, proliferating hemangiomas, Dr. Margitta Poetke of the Elisabeth Klinik in Berlin said at the Excellence in Paediatrics meeting.
Photo courtesy University of California Regents.
Propranolol combined with laser may be an alternative to corticosteriods for treating infant hemangiomas.
Since 2008, when the use of propranolol was first proposed for the treatment for infantile hemangiomas (N. Engl. J. Med. 2008;358:2649-51), there have been several studies investigating its potential use. Dr. Poetke and her team reported their first experience of using propranolol in combination with laser therapy.
Hemangiomas are abnormal buildups of blood vessels in the skin or internal organs. They typically occur after the age of 3 months, rapidly proliferate and mature between 6 months and 1 year, and then regress until they partially or fully resolve by the age of 5-7 years.
The small study involved 23 infants with hemangiomas and other benign large vessel tumors who were between ages 2 months and 3.5 years. All infants had facial hemangiomas that were causing severe functional impairment, such as occlusion of the eye or destruction of the lip.
Nine infants were treated with propranolol (2 mg/kg per day) alone, and 14 received the beta-blocker in combination with laser therapy; 7 had received prior oral corticosteroid therapy. Treatment was for 6-8 months, with 2-18 months’ follow-up. The effects of treatment were assessed using color-coded duplex sonography, with photographs taken at 1, 3, and 6 months, and after the end of therapy.
Of the nine infants treated with propranolol only, those with cutaneous hemangiomas responded better than those with subcutaneous hemangiomas, and treatment appeared to be more effective in the younger children (less than 6 months) than in older children. Full regression of the hemangiomas was not always achieved on treatment, however, and rebound growth was seen after treatment was halted in six children – two with subcutaneous hemangiomas and four with cutaneous/subcutaneous hemangiomas.
Propranolol plus laser therapy appeared to be more effective, with only one rebound hemangioma occurring in a child with a cutaneous/subcutaneous hemangioma out of 14 children treated with the combination. The reason for this rebound may be that the child received only one treatment, Dr. Poetke said.
"Laser treatment in combination with propranolol seems to have an additive, positive effect," said Dr. Poetke. She noted that the combination lightened the skin and flattened lesions, and "the risk of a rebound growth seems to be much lower."
Side effects included nocturnal restlessness, listlessness, reduced hair growth, and diarrhea, which affected one child each, and bradycardia in two children. Treatment was stopped because of suckling weakness in one child, and because of no effect in another.
These data suggest that propranolol plus laser therapy may be an alternative approach to corticosteroids in the first-line medical treatment of infant hemangiomas, Dr. Poetke said. With potentially fewer side effects and less chance of rebound hemangioma than corticosteroids, propranolol may be safer and more effective, particularly when combined with laser treatment.
Treatment with propranolol needs to start early, however, be given for at least 6 months, and, ideally, be combined with laser therapy to optimize the regression of the hemangioma and to avoid regrowth, she said.
Dr. Poetke said she had no relevant financial disclosures.