Propranolol for recalcitrant ulcerated hemangioma of infancy

Hemangioma of infancy (HOI) is a common, self-resolving, benign tumor that frequently requires no intervention. Ulceration is one of the main complications of HOI, and active treatment is usually required to manage pain, potential scarring, and occasionally bleeding and infection. Since the discovery that oral propranolol is an effective treatment for complicated HOI, it has been replacing systemic corticosteroids as first-line therapy, and early recommendations for treatment protocols have been devised. We report the successful treatment of six children with recalcitrant ulcerated HOI using propranolol. In all cases, complete, rapid healing occurred. Two children experienced recurrence of ulceration after ceasing propranolol, but this was rapidly controlled by restarting treatment. No adverse effects were encountered. We propose that ulceration in HOI is an indication for propranolol treatment if more conservative therapies have failed.