Therapeutic superiority of combined propranolol with short steroids course over propranolol monotherapy in infantile hemangioma

Abstract

Infantile hemangiomas are the most common benign childhood tumor that may have functional and/or cosmetic complications. We aimed to compare the clinical efficacy of propranolol alone and propranolol primed with systemic corticosteroids on the outcome of infantile hemangioma. A prospective randomized study included 40 infants aged less than 9 months with cutaneous hemangiomas. Patients were randomly assigned into two groups: group A were given oral prednisolone for the initial 2 weeks combined with oral propranolol, while group B were given oral propranolol alone for 6 months. The median age of the studied patients was 4.5 months (ranged 4 weeks–8 months). Sequential determination of the dimensions of the hemangiomas based on direct measurement and photographic analysis were performed. A significant reduction in the size of the lesions was found in group A in the 2-, 4-, and 8-week evaluation compared to group B (p < 0.001) with no statistical difference in the ultimate 6 month response (p = 0.134). Multiple logistic regression showed that early treatment before 6 months of age (OR 9.82, p = 0.007) and combined treatment with propranolol and prednisolone (OR 10.71, p = 0.006) were the predictors of best response. Conclusion: Combining propranolol with corticosteroids gives a faster response and should be considered in treating life- or function-threatening hemangiomas.What is Known:• Steroids monotherapy was replaced by propranolol monotherapy in the practice of treatment of IH. Variable resistance to each of the two medications has been reported.What is New:• This randomized trial revealed that priming propranolol therapy with a short prednisolone course showed a faster response in complicated IH with minimal side effects.