Hemangioma medical therapy

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]

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 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]
  • Corticosteroids
  • Interferon
  • Vincristine
• These agents have also been used for:^[1]
  • Multifocal disease
  • Visceral involvement
  • Segmental distribution
  • Airway obstruction
  • Periorbital lesions

• 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:

• Oral regimen
  • Preferred regimen (1): Propranolol 0.5 mL/kg PO q12h for 7 days;
    • Propranolol 0.3 mL/kg PO q12h for 7 days;
    • Propranolol 0.4 mL/kg PO q12h for 6 months

Beyond proliferative phase

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

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