Heart Drug Propranolol May Help Hemagiomas
An article in the June 12, 2008 issue of the New England Journal of Medicine that shows some amazing regression of hemagiomas using propranolol.
Christine Léauté-Labrèze, M.D., of Bordeaux Children's Hospital, and colleagues used the drug propranolol to treat two infants with heart disease (one with cardiomyopathy, the another with increased cardiac output) who just happened to also have hemangiomas. Unexpectedly, the lesions began to fade. They then used propranolol on nine other children with hemangiomas with similar success.
Johns Hopkins researchers have developed a protocol for the beta-blocker as a first-line treatment for the skin disorder. Propranolol could replace or supplement steroids such as prednisone which are often used currently.
Prednisone use carries the side effects of growth retardation, elevated blood sugars, and reduced resistance to infection.
Propranolol has side effects that include hypotension and hypoglycemia, but these are short-lived.
So far, Dr. Cohen and Katherine Puttgen, M.D., also at Johns Hopkins, say they have treated 20 patients with propranolol. Working with cardiologists, they decided to hospitalize the infants for the first two days of treatment to monitor for possible side effects such as hypotension or hypoglycemia. They have seen neither hypotension or hypoglycemia in the infants treated so far.
Hemangiomas of infancy are the most common tumor of infancy. They appearing in 10% of newborns by 2 months of age. Most of these lesions are innocuous and regress without treatment by the time the child reaches school age. However, 5-10% of the lesions that will ulcerate during the rapid growth phase in the first 6 months of life. Ulceration is the most common reason for referral to specialists, and may be associated with pain, bleeding, infection, disfigurement, and scarring.
Researchers aren't sure why hemangiomas occur. Approximately 75 percent occur in girls. They're also more common in white babies than African-American children, and more likely to appear in babies who were premature or whose mothers had complicated pregnancies.
Dr. Léauté-Labrèze, and colleagues report that they are applying for a patent for the use of beta-blockers in infantile capillary hemangiomas.
Propranolol for severe hemangiomas of infancy; New Engl J Med 2008; 358: 2649-2651; Léauté-Labrèze, C et al
Ulcerated Hemangiomas of Infancy: Risk Factors and Management Strategies; eLiterature Review (John Hopkins Medicine) , Oct 2007, Vol 1, No 4; Bernard A. Cohen, MD, Susan Matra Rabizadeh, MD, MBA, Mark Lebwohl, MD, and Elizabeth Sloand, PhD, CRNP
This one series of photos shows (see above) the results of hemagioma regression in one of the infants.