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Evolving strategy in treatment of infantile hemangiomas: from steroids to propranolol

Year 2016, Volume: 41 Issue: 2, 354 - 359, 30.06.2016
https://doi.org/10.17826/cutf.201781

Abstract

Infantile hemangiomas are the most common vascular tumors of the early childhood. Increased incidence of infantile hemangiomas can be attributed to widespread use of assisted reproductive technologies. Majority of hemangiomas in infantile age group resolve spontaneously and only a small proportion of the cases with infantile hemangiomas requires treatment. GLUT-ONE acronym (Giant infantile hemangiomas, Liver and/or other visceral organ involvement, Ulcerated or bleeding infantile hemangiomas, Threatening of life, Organ dysfunctioning infantile hemangiomas, Non-localized infantile hemangiomas, Esthetic/cosmetic compromise) can help clinicians for the rapid decision of treatment. Corticosteroids have long been the mainstay treatment for hemangiomatous lesions but after the description of antiproliferative effect of propranolol on severe infantile hemangiomas in 2008, propranolol has been the preferred choice of treatment in many centers. Future studies should be directed to answer the questions regarding the optimal duration of propranolol treatment to overcome recurrences and clinical and histopathological characteristics of infantile hemangiomas that failed treatment with propranolol.

References

  • Nguyen J, Fay A. Pharmacologic therapy for periocular infantile hemangiomas: a review of the literature. Semin Ophthalmol. 2009;24:178-84.
  • Nozaki T, Matsusako M, Mimura H, Osuga K, Matsui M, Eto H et al. Imaging of vascular tumors with an emphasis on ISSVA classification. Jpn J Radiol. 2013;31:775-85.
  • Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol. 2008;25:168-73.
  • Haggstrom AN, Lammer EJ, Schneider RA, Marcucio R, Frieden IJ. Patterns of infantile hemangiomas: pathogenesis and embryonic facial development. Pediatrics. 2006;117:698-703. to hemangioma
  • Küpeli S, Cimen D, Küpeli BY. Successful treatment with propranolol in a patient with a segmental hemangioma: a case report. Turk J Haematol. 2012;29:170-3.
  • Gnarra M, Solman L, Harper JI, Syed SB. Propranolol and prednisolone combination for the treatment of segmental haemangioma in PHACES syndrome. Br J Dermatol. 2015;99:1132-6.
  • Chiu YE, Drolet BA, Blei F, Carcao M, Fangusaro J, Kelly ME et al. Variable response to propranolol treatment of kaposiform hemangioendothelioma, tufted angioma, and Kasabach-Merritt phenomenon. Pediatr Blood Cancer. 2012;59:934-8.
  • Leboulanger N, Fayoux P, Teissier N, Cox A, Van Den Abbeele T, Carrabin L et al. Propranolol in the therapeutic strategy of infantile laryngotracheal hemangioma: A preliminary retrospective study of French experience. Int J Pediatr Otorhinolaryngol. 2010;74:1254-7.
  • Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics. 2013;131:128-40.
  • Zarem HA, Edgerton MT. Induced resolution of cavernous hemangiomas following prednisolone therapy. Plast Reconstr Surg. 1967;39:76-83.
  • Zweifach BW, Shorr E, Black MM. The influence of the adrenal cortex on behavior of terminal vascular bed. Ann N Y Acad Sci. 1953;56:626-33.
  • Hasan Q, Tan ST, Xu B, Davis PF. Effects of five commonly used glucocorticoids on haemangioma in vitro. Clin Exp Pharmacol Physiol. 2003;30:140-4.
  • Küpeli S, Cimen D, Yağcı Küpeli B. Megadose methylprednisolone (MDMP) for hemangiomatosis. Turk J Haematol. 2012;29:437.
  • Ozsoylu S, Irken G, Gürgey A. High dose intravenous methylprednisolone for Kassabach- Merritt syndrome. Eur J Pediatr. 1989;148:403-5.
  • Aulakh R, Singh S. Strategies for minimizing corticosteroid toxicity: a review. Indian J Pediatr. 2008;75:1067-73.
  • Garzon MC, Lucky AW, Hawrot A, Frieden IJ. Ultrapotent topical corticosteroid treatment of hemangiomas of infancy. J Am Acad Dermatol. 2005;52:281-6.
  • Ezekowitz RA, Mulliken JB, Folkman J. Interferon alfa-2a therapy for life-threatening hemangiomas of infancy. N Engl J Med. 1992;326:1456-63.
  • Yoon HS, Lee JH, Moon HN, Seo JJ, Im HJ, Goo HW. Successful treatment of retroperitoneal infantile hemangioendothelioma syndrome using steroid, alpha-interferon, and vincristine. J Pediatr Hematol Oncol. 2009;31:952-4.
  • Vlahovic A, Simic R, Djokic D, Ceran C. Diffuse neonatal cyclophosphamide: a case report. J Pediatr Hematol Oncol. 2009;31:858-60. treatment with
  • Fukushima H, Kudo T, Fuskushima T, Takahashi- Igari M, Shiigai M et al. An infant with life- threatening hemangioma successfully treated with low-dose 2011;53:1073-5. Pediatr Int.
  • Craiglow BG, Antaya RJ. Management of infantile hemangiomas pharmacotherapeutic approaches. Paediatr Drugs. 2013;15:133-8. and potential
  • Hammill AM, Wentzel M, Gupta A, Nelson S, Lucky A, Elluru R et al. Sirolimus for the treatment of complicated vascular anomalies in children. Pediatr Blood Cancer. 2011;57:1018-24.
  • Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358:2649-51.
  • Bertrand J, McCuaig C, Dubois J, Hatami A, Ondrejchak S, Powell J. Propranolol versus prednisone in the treatment of infantile hemangiomas: a retrospective comparative study. Pediatr Dermatol. 2011;28:649-54.
  • Malik MA, Menon P, Rao KL, Samujh R. Effect of propranolol vs prednisolone vs propranolol with prednisolone in the management of infantile hemangioma: a randomized controlled study. J Pediatr Surg. 2013;48:2453-9.
  • Ji Y, Chen S, Xu C, Li L, Xiang B. The use of propranolol in the treatment of infantile haemangiomas: an update on potential mechanisms of action. Br J Dermatol. 2015;172:24-32.
  • Konrad D, Ellis G, Perlman K. Spontaneous regression hypothyroidism associated with multiple liver hemangiomas. Pediatrics. 2003;112:1424-6. infantile
  • Raphael MF, Breugem CC, Vlasveld FA, de Graaf M, Slieker MG, Pasmans SG et al. Is cardiovascular evaluation necessary prior to and during beta-blocker therapy for infantile hemangiomas? A cohort study. J Am Acad Dermatol. 2015;72:465-72.
  • Sethuraman G, Yenamandra VK, Gupta V. Management of infantile hemangiomas: current trends. J Cutan Aesthet Surg. 2014;7:75-85.
  • Sommers Smith SK, Smith DM. Beta blockade induces apoptosis in cultured capillary endothelial cells. In Vitro Cell Dev Biol Anim. 2002;38:298-304.
  • Ovadia SA, Landy DC, Cohen ER, Yang EY, Thaller SR. Local Administration of β-Blockers for Infantile Hemangiomas: A Systematic Review and Meta- analysis. Ann Plast Surg. 2015;74:256-62.
  • Fuchsmann C, Quintal MC, Giguere C, Ayari- Khalfallah S, Guibaud L, Powell J et al. Propranolol as first-line treatment of head and neck hemangiomas. Arch Otolaryngol Head Neck Surg. 2011;137:471-8.
  • Hermans DJ, Bauland CG, Zweegers J, van Beynum IM, van der Vleuten CJ. Propranolol in a case series of 174 patients with complicated infantile haemangioma: Indications, safety and future directions. Br J Dermatol. 2013;168:837–43.
  • Schupp CJ, Kleber JB, Günther P, Holland-Cunz S. Propranolol therapy in 55 infants with infantile hemangioma: Dosage, duration, adverse effects, and outcome. Pediatr Dermatol. 2011;28:640–4.
  • Küpeli S. Use of propranolol for infantile hemangiomas. Pediatr Hematol Oncol. 2012;29:293- 8.
  • Phillips RJ, Lokmic Z, Crock CM, Penington A. Infantile haemangiomas that failed treatment with propranolol: clinical and histopathological features. J Paediatr Child Health. 2014;50:619-25

İnfantil hemanjiyomlarda steroidlerden propranolole gelişen tedavi stratejisi

Year 2016, Volume: 41 Issue: 2, 354 - 359, 30.06.2016
https://doi.org/10.17826/cutf.201781

Abstract

İnfantil hemanjiyomlar erken çocukluk döneminde en sık görülen damarsal tümörlerdir. İnfantil hemanjiyomların insidansında görülen artıştan yardımcı üreme tekniklerinin yaygın olarak kullanılmaya başlanması da sorumlu tutulmaktadır. Çoğu infantil dönemde kendiliğinden gerilese de infantil hemanjiyomların küçük bir kısmı tedavi gerektirmektedir. Bu derlemede sunulan GLUT-ONE akrostişi (dev infantil hemanjiyomlar, karaciğer ve/veya iç organları tutan infantil hemanjiyomlar, ülsere veya kanamalı infantil hemanjiyomlar, yaşamı tehdit eden infantil hemanjiyomlar, organ disfonksiyonuna neden olan infantil hemanjiyomlar, lokalize olmayan infantil hemanjiyomlar, estetik/kozmetik bozukluğa neden olan infantil hemanjiyomlar) klinisyenlere tedavi endikasyonları konusunda yardımcı olabilecektir. Kortikosteroidler uzunca bir süreden beri tedavinin ana unsuru olsalar da 2008 yılında propranololün antiproliferatif etkisi tanımlandıktan sonra birçok merkezde propranolol infantil hemanjiyomların tedavisinde ilk tercih edilen ilaç olmuştur. Gelecekteki çalışmalar tedavi sonrasında rekürrensleri önlemek adına uygulanması gereken süre ve propranolol tedavisine yanıtsız infantil hemanjiyomların histopatolojik özellikleri gibi konulara odaklanmalıdır.

References

  • Nguyen J, Fay A. Pharmacologic therapy for periocular infantile hemangiomas: a review of the literature. Semin Ophthalmol. 2009;24:178-84.
  • Nozaki T, Matsusako M, Mimura H, Osuga K, Matsui M, Eto H et al. Imaging of vascular tumors with an emphasis on ISSVA classification. Jpn J Radiol. 2013;31:775-85.
  • Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol. 2008;25:168-73.
  • Haggstrom AN, Lammer EJ, Schneider RA, Marcucio R, Frieden IJ. Patterns of infantile hemangiomas: pathogenesis and embryonic facial development. Pediatrics. 2006;117:698-703. to hemangioma
  • Küpeli S, Cimen D, Küpeli BY. Successful treatment with propranolol in a patient with a segmental hemangioma: a case report. Turk J Haematol. 2012;29:170-3.
  • Gnarra M, Solman L, Harper JI, Syed SB. Propranolol and prednisolone combination for the treatment of segmental haemangioma in PHACES syndrome. Br J Dermatol. 2015;99:1132-6.
  • Chiu YE, Drolet BA, Blei F, Carcao M, Fangusaro J, Kelly ME et al. Variable response to propranolol treatment of kaposiform hemangioendothelioma, tufted angioma, and Kasabach-Merritt phenomenon. Pediatr Blood Cancer. 2012;59:934-8.
  • Leboulanger N, Fayoux P, Teissier N, Cox A, Van Den Abbeele T, Carrabin L et al. Propranolol in the therapeutic strategy of infantile laryngotracheal hemangioma: A preliminary retrospective study of French experience. Int J Pediatr Otorhinolaryngol. 2010;74:1254-7.
  • Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics. 2013;131:128-40.
  • Zarem HA, Edgerton MT. Induced resolution of cavernous hemangiomas following prednisolone therapy. Plast Reconstr Surg. 1967;39:76-83.
  • Zweifach BW, Shorr E, Black MM. The influence of the adrenal cortex on behavior of terminal vascular bed. Ann N Y Acad Sci. 1953;56:626-33.
  • Hasan Q, Tan ST, Xu B, Davis PF. Effects of five commonly used glucocorticoids on haemangioma in vitro. Clin Exp Pharmacol Physiol. 2003;30:140-4.
  • Küpeli S, Cimen D, Yağcı Küpeli B. Megadose methylprednisolone (MDMP) for hemangiomatosis. Turk J Haematol. 2012;29:437.
  • Ozsoylu S, Irken G, Gürgey A. High dose intravenous methylprednisolone for Kassabach- Merritt syndrome. Eur J Pediatr. 1989;148:403-5.
  • Aulakh R, Singh S. Strategies for minimizing corticosteroid toxicity: a review. Indian J Pediatr. 2008;75:1067-73.
  • Garzon MC, Lucky AW, Hawrot A, Frieden IJ. Ultrapotent topical corticosteroid treatment of hemangiomas of infancy. J Am Acad Dermatol. 2005;52:281-6.
  • Ezekowitz RA, Mulliken JB, Folkman J. Interferon alfa-2a therapy for life-threatening hemangiomas of infancy. N Engl J Med. 1992;326:1456-63.
  • Yoon HS, Lee JH, Moon HN, Seo JJ, Im HJ, Goo HW. Successful treatment of retroperitoneal infantile hemangioendothelioma syndrome using steroid, alpha-interferon, and vincristine. J Pediatr Hematol Oncol. 2009;31:952-4.
  • Vlahovic A, Simic R, Djokic D, Ceran C. Diffuse neonatal cyclophosphamide: a case report. J Pediatr Hematol Oncol. 2009;31:858-60. treatment with
  • Fukushima H, Kudo T, Fuskushima T, Takahashi- Igari M, Shiigai M et al. An infant with life- threatening hemangioma successfully treated with low-dose 2011;53:1073-5. Pediatr Int.
  • Craiglow BG, Antaya RJ. Management of infantile hemangiomas pharmacotherapeutic approaches. Paediatr Drugs. 2013;15:133-8. and potential
  • Hammill AM, Wentzel M, Gupta A, Nelson S, Lucky A, Elluru R et al. Sirolimus for the treatment of complicated vascular anomalies in children. Pediatr Blood Cancer. 2011;57:1018-24.
  • Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358:2649-51.
  • Bertrand J, McCuaig C, Dubois J, Hatami A, Ondrejchak S, Powell J. Propranolol versus prednisone in the treatment of infantile hemangiomas: a retrospective comparative study. Pediatr Dermatol. 2011;28:649-54.
  • Malik MA, Menon P, Rao KL, Samujh R. Effect of propranolol vs prednisolone vs propranolol with prednisolone in the management of infantile hemangioma: a randomized controlled study. J Pediatr Surg. 2013;48:2453-9.
  • Ji Y, Chen S, Xu C, Li L, Xiang B. The use of propranolol in the treatment of infantile haemangiomas: an update on potential mechanisms of action. Br J Dermatol. 2015;172:24-32.
  • Konrad D, Ellis G, Perlman K. Spontaneous regression hypothyroidism associated with multiple liver hemangiomas. Pediatrics. 2003;112:1424-6. infantile
  • Raphael MF, Breugem CC, Vlasveld FA, de Graaf M, Slieker MG, Pasmans SG et al. Is cardiovascular evaluation necessary prior to and during beta-blocker therapy for infantile hemangiomas? A cohort study. J Am Acad Dermatol. 2015;72:465-72.
  • Sethuraman G, Yenamandra VK, Gupta V. Management of infantile hemangiomas: current trends. J Cutan Aesthet Surg. 2014;7:75-85.
  • Sommers Smith SK, Smith DM. Beta blockade induces apoptosis in cultured capillary endothelial cells. In Vitro Cell Dev Biol Anim. 2002;38:298-304.
  • Ovadia SA, Landy DC, Cohen ER, Yang EY, Thaller SR. Local Administration of β-Blockers for Infantile Hemangiomas: A Systematic Review and Meta- analysis. Ann Plast Surg. 2015;74:256-62.
  • Fuchsmann C, Quintal MC, Giguere C, Ayari- Khalfallah S, Guibaud L, Powell J et al. Propranolol as first-line treatment of head and neck hemangiomas. Arch Otolaryngol Head Neck Surg. 2011;137:471-8.
  • Hermans DJ, Bauland CG, Zweegers J, van Beynum IM, van der Vleuten CJ. Propranolol in a case series of 174 patients with complicated infantile haemangioma: Indications, safety and future directions. Br J Dermatol. 2013;168:837–43.
  • Schupp CJ, Kleber JB, Günther P, Holland-Cunz S. Propranolol therapy in 55 infants with infantile hemangioma: Dosage, duration, adverse effects, and outcome. Pediatr Dermatol. 2011;28:640–4.
  • Küpeli S. Use of propranolol for infantile hemangiomas. Pediatr Hematol Oncol. 2012;29:293- 8.
  • Phillips RJ, Lokmic Z, Crock CM, Penington A. Infantile haemangiomas that failed treatment with propranolol: clinical and histopathological features. J Paediatr Child Health. 2014;50:619-25
There are 36 citations in total.

Details

Primary Language English
Journal Section Review
Authors

Serhan Küpeli

Publication Date June 30, 2016
Published in Issue Year 2016 Volume: 41 Issue: 2

Cite

MLA Küpeli, Serhan. “Evolving Strategy in Treatment of Infantile Hemangiomas: From Steroids to Propranolol”. Cukurova Medical Journal, vol. 41, no. 2, 2016, pp. 354-9, doi:10.17826/cutf.201781.