Infantile haemangiomas that failed treatment with propranolol: clinical and histopathological features
Roderic J Phillips1, Zerina Lokmic, Catherine M Crock
1Vascular Biology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Paediatrics, Monash University, Melbourne, Victoria, Australia.
Insights
A 10% failure rate for infantile haemangioma treatment with propranolol was observed, higher than previously reported. Focal facial lesions were twice as likely to resist treatment, with no clear histopathological cause found.
Area of Science:
- Vascular biology
- Pediatric dermatology
- Histopathology
Background:
- Infantile haemangiomas are common vascular tumors in infants.
- Oral propranolol is a first-line treatment for problematic infantile haemangiomas.
- Treatment failure necessitates understanding underlying characteristics.
Purpose of the Study:
- To investigate the clinical and histopathological features of infantile haemangiomas resistant to oral propranolol therapy.
- To compare non-responding haemangiomas with those that responded to treatment.
Main Methods:
- A case series design was employed at a specialized vascular birthmarks clinic.
- Infants treated with oral propranolol for at least 4 months without satisfactory results were identified.
- Histological and immunohistochemical analysis of non-responding haemangiomas and controls was performed.
Main Results:
- 14 out of 135 infants (10.4%) showed treatment failure with oral propranolol.
- Focal facial haemangiomas were disproportionately represented among non-responders.
- No significant differences in tissue morphology, innervation, or beta-2 adrenergic receptor expression were found between responding and non-responding haemangiomas.
Conclusions:
- The observed treatment failure rate of 10% for infantile haemangiomas with propranolol is higher than previously documented.
- Focal facial infantile haemangiomas demonstrate a higher propensity for treatment resistance.
- Current histopathological markers do not explain the lack of response to propranolol in certain infantile haemangiomas.
Aim:
To describe the clinical and histopathological characteristics of infantile haemangiomas that failed treatment with oral propranolol .
Design:
This study is a case series from the vascular birthmarks clinic at Royal Children's Hospital, Melbourne.
Patients:
The patients for this study were infants who commenced treatment with oral propranolol before 6 months of age and who were treated for at least 4 months without a satisfactory result. For histology and immunohistochemistry, tissue from the four non-responding patients who subsequently underwent surgical excision was matched with four historical controls.
Outcome Measures:
Based on medical record review and photographic assessments, infants were defined as having failed treatment with oral propranolol if the infantile haemangioma either continued to grow or showed 20% improvement or less. Tissue sections were examined for tissue structure, mast cells, sympathetic innervations and beta-2 adrenergic receptor expression, and the number of mast cells and beta-2 adrenergic positive cells.
Results:
From a group of 135 infants who met the inclusion criteria, 14 infants failed propranolol treatment. Eleven of these infants had focal facial haemangiomas. No difference was seen in tissue morphology, tissue innervations, beta-2 adrenergic receptor expression, cell number or mast cell distribution, and number between non-responding and control haemangiomas.
Conclusion:
We report a treatment failure rate of 10%, which is higher than previously reported. Focal facial lesions failed to respond twice as frequently as other types of haemangioma. No histopathological reason was identified to indicate why some haemangiomas failed to respond.
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