Elsevier

Journal of Pediatric Surgery

Volume 48, Issue 12, December 2013, Pages 2453-2459
Journal of Pediatric Surgery

PAPS Papers
Effect of propranolol vs prednisolone vs propranolol with prednisolone in the management of infantile hemangioma: A randomized controlled study

https://doi.org/10.1016/j.jpedsurg.2013.08.020Get rights and content

Abstract

Aims and Objectives

The purpose of this study was to compare the efficacy of orally administered propranolol versus prednisolone versus both in the treatment of potentially disfiguring or functionally threatening infantile hemangiomas.

Material and Methods

A prospective study of 30 patients aged 1 week–8 months was randomized into three equal groups. These were as follows: A, propranolol (2–3 mg/kg/d); B, prednisolone (1–4 mg/kg/d); and C, receiving both for a minimum duration of 3 months. Dimensions, color, consistency, ultrasonography, photographic documentation based on Visual Analogue Scale (VAS) were recorded before and periodically after starting treatment. A minimum 75% improvement was considered as success with no regrowth up to 1 month of stopping treatment.

Results

Mean initial response time (days) in A (4.1 ± 3.3 SD) and C (4.7 ± 3.4SD) was significantly lower than B (9.78 ± 7.8SD) (p < 0.047). Significant change in consistency was noted very early in A (24 hours) compared to B and C (8 days). VAS results are as follows: (a) color fading—significant reduction in A within 48 hours compared to B and C (p = 0.025), (b) flattening—more significant and earlier in A and C than B (p < 0.05), and (c) mean reduction in size: significant in A and C at 3 months (p = 0.005, p = 0.005), 6 months (p = 0.005, p = 0.008), 12 months (p = 0.005, p = 0.008), and 18 months (p = 0.02, p = 0.04), whereas in B, it was seen only at 6 months (p = 0.008).

Conclusions

Propranolol had a consistent, rapid therapeutic effect compared to prednisolone. A combination of the two had a comparable but not higher efficacy than propranolol alone. Prednisolone was associated with a higher number of complications, thereby decreasing patient compliance.

Section snippets

Material and methods

Thirty patients with IHs attending the outpatient department of a tertiary referral hospital from January 2011 to July 2012 complying with the following criteria were included in the study: age group—1 week to 8 months of either sex and problematic IHs with potentially disfiguring lesions in the face or functionally threatening lesions of the limbs, genitalia or natural orifices. The following were excluded: uncomplicated lesions of trunk, extremities; presence of heart disease, cardiac

Results

The overall male/female ratio was 3:2. (A 2.1:1, B 2:3 and C 2.1:1). No patient was on any concomitant therapy at the time of initiation of treatment.

Mean age of initiation of treatment was 4.6 months (1–8) in group A, 5.5 months (2–8) in group B and 4.7 (1–8) months in group C. Head and neck were the most common locations in 66% (n = 20). Parotid was the most common site in head and neck region contributing 30% of total cases, followed by lip (13.3%) and scalp (10%). The most common type of lesion

Discussion

Hemangiomas are benign growths of endothelial cells presenting anywhere in the skin, mucous membranes, or underlying viscera. They most commonly occur in the head and neck region as seen in our study also where they accounted for 66% of the cases [5]. There were more males than females (3:2) in our study as compared to the literature where it is quoted to occur 2.2 to 4.5 times more often in females [1].

Up to 10% of IHs may cause obstruction of the upper airway/eye, ulceration, bleeding,

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