Hemangiomas – Medical Management – Propranolol
Propranolol is an antihypertensive drug that has been found to be active against hemangiomas. This was first noted in 2008 and caused much excitement in this field. The drug’s effect appears to be active during both the proliferative phase (active growth) and the involution phase (regression). We have recently treated patients as late as two to two and a half years of age (segmental hemangioma) with propranolol and we are surprised to see an effect. The mechanism of action remains unknown and to date the only side effect documented appears to be a sudden drop in the blood glucose level of the child. This is usually seen when the child misses a meal. For this reason, we usually advise the parents to give the drug after a meal. If for some reason the child does not consume a sufficient quantity of food, the parents are then instructed to skip that dose. A make-up dose is not required. In this way, we prevent a drop in the blood glucose level. Superficial hemangiomas may be treated with topical timolol (topical version of propranolol).
We usually treat children with focal hemangiomas until about eight to ten months of age. This will hopefully prevent rebound growth. Children with segmental hemangiomas require a longer term of treatment due to the fact that segmental hemangiomas can proliferate for up to twenty-four months.