Efficacy of topical treatment with 1% propranolol ointment in infantile hemangioma

Abstract

Infantile hemangiomas (IH) are the most common vascular tumors in children, affecting 5-10% of infants up to 1 year of age (Munden et al., 2014; Puttgen, 2014). The target group consists of newborns 1.1-2.6%, more frequently in female infants, Caucasians, and infants with lower birth weight (Puttgen 2014; Wang et al.2017; Price et al.2018). In the last decade, Propranolol has been widely used in the treatment of IH, with good results (Mannshreck DB, Huang AH, Lie E, Psoter K., 2019). The mechanisms induced by propranolol result in vasoconstriction, inhibition of angiogenesis, and induction of apoptosis; these develop rapidly and substantially reduce the lesions, with minimal adverse reactions (Storch C. H. et al., 2010; Ni N. et al., 2011; Drolet B.A. et al., 2013). Objective to evaluate the efficacy of local treatment with Propranolol in hemangiomas in children. Materials and methods The study included 31 patients with IH (f/m - 13/18, ages 1-9 months). Solitary IH lesions were present in 28 children, while 3 patients presented 2-3 lesions, totaling 36 lesions included in the study. The recorded locations were as follows: cervicofacial - 12 lesions; trunk - 18, extremities - 6 lesions. Distribution of hemangiomas according to the level of involvement: superficial - 24, mixed - 10, deep - 2. Distribution by lesion diameter: 0.1-3 cm - 15; 3.1-6 cm - 7; 6.1-9 cm - 5; >9 cm - 10 lesions. Evaluation of hemangiomas was performed through objective examination, photography, and ultrasonography at the first visit, at 3 and 6 months of treatment. Treatment was performed with 1% Propranolol ointment, applied three times a day. Consistency and color were changed in all hemangiomas after 3 months of treatment. Hemangioma thickness (according to USG data) changed as follows: 100%-3, 50-90%-4, 25-50%-14, <25%-12 (3 patients were not examined by USG). Response to topical propranolol treatment was assessed on a 4-point scale, taking into consideration clinical indices (flattening, size, and color of lesions), including: very good response (reduction of lesions >90% and complete decolorization of color), good response (reduction of lesions ≥50% and significant decolorization of color), moderate response (reduction of lesions ≥25%, minimal decolorization of color), poor response (reduction of lesions <20%).Results The average age of patients with IH was 3.9 months. Over the course of 3 months from the initiation of topical treatment with 1% Propranolol ointment, considerable changes regarding the reduction of density, size, and color of tumors were observed in all patients. The curative response to final treatment (6 months of treatment) was as follows: very good response - 4 (11.11%) cases; good response - 9 (25%) cases; moderate response - 13 (36.11%) cases; poor response - 10 (27.8%) cases. During treatment, 2 patients had mild contact dermatitis with the administration of the preparation, which was easily treated with dermatocosmetics, and the patients continued therapy. No other adverse reactions were reported. Conclusions Our study confirms the high curative efficacy of topical propranolol indicated in patients with superficial and mixed IH over 6 months, applied three times a day. Significant changes in tumors were noted in the first 3 months of treatment. Good tolerance to 1% topical propranolol ointment was observed, with no significant adverse reactions.