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Propranolol for the treatment of infantile haemangiomas: our experience with 44 patients
M Lynch1, P Lenane, B F O'Donnell
1Children's University Hospital, Dublin, Ireland.
Insights
Propranolol effectively treats complicated infantile haemangiomas (IH). Most patients responded well, though some experienced rebound growth or minor side effects, necessitating longer treatment durations in some cases.
Area of Science:
- Dermatology
- Pediatrics
- Pharmacology
Background:
- Infantile haemangiomas (IH) are common vascular tumors in infants.
- Complicated IH can lead to functional deficits, cosmetic concerns, and systemic complications.
- Propranolol has emerged as a first-line treatment for IH.
Purpose of the Study:
- To evaluate the efficacy and safety of propranolol for complicated infantile haemangiomas.
- To assess treatment duration, response rates, and adverse events in a real-world clinical setting.
Main Methods:
- Retrospective evaluation of 44 patients with complicated IH treated with propranolol.
- Data collection on treatment duration, response, rebound growth, and adverse effects.
- Analysis of outcomes, including specific considerations for patients with PHACES syndrome.
Main Results:
- All 26 patients who completed treatment showed a good response.
- Mean treatment duration was 45.7 weeks.
- Four patients experienced rebound growth, responsive to propranolol reintroduction; three discontinued treatment due to adverse effects (vomiting, wheeze, hypoglycemia).
- Hypotension occurred in 27.3% of patients, potentially prolonging treatment duration.
Conclusions:
- Propranolol is an effective and generally safe first-line treatment for complicated infantile haemangiomas.
- Longer treatment durations may be necessary in some cases, particularly with comorbidities like hypotension.
- Careful monitoring for adverse effects and potential complications is essential.
Abstract:
Propranolol is an effective, safe treatment for complicated infantile haemangiomas (IH). We evaluated all patients (n = 44) with IH treated with propranolol in our department. Of the 44 patients who were begun on propranolol therapy, 26 patients have completed the treatment to date and all had a good response. The mean duration of treatment was 45.7 weeks. Four patients developed rebound growth of their IH, which responded to the reintroduction of propranolol. Two patients with PHACES (posterior fossa malformations, haemangiomas, arterial anomalies, coarctation of the aorta/cardiac abnormalities, eye anomalies and sternal defects/supraumbilical raphe) syndrome were treated with lower than standard doses, because of concern about possible cerebrovascular compromise. Adverse effects were minor in most patients. Three patients discontinued propranolol because of vomiting, wheeze, and hypoglycaemia, respectively. Our duration of treatment was longer than that of other series, and may be due to our group having higher rates of hypotension, recorded in 27.3% of patients, precluding an increase in propranolol dose. Our experience supports that propranolol is an effective first-line agent for complicated IH.
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