We read with great interest the article entitled “Resection of Amblyogenic Periocular Hemangiomas: Indications and Outcomes,” particularly the section on their management.1 We are all too aware of the difficulties, such as timing of intervention and the inadequacy of conventional therapies.
We agree with the authors regarding the role of early resection of a well-localized periocular hemangioma to prevent potentially irreversible amblyopia caused by either corneal deformation or blepharoptosis and the partial response with oral or intralesional steroids. Intralesional or oral corticosteroid administration was attempted in almost half of the authors' series.
Recently, a number of cases have been reported regarding the efficacy of propranolol in the treatment of hemangioma.2,3 As part of a larger study, we have used propranolol in a total of 27 patients, including seven periocular hemangiomas as a first-line management. We have noticed a considerable improvement in both color and thickness within the first 24 hours and a halt in lesion progression in 100 percent within 48 hours. Furthermore, 50 percent of the lesions have shown significant reduction within 4 weeks of treatment of propranolol alone. So far, there have been no side effects to treatment, in contrast to other reports.4 Consequently, we now offer propranolol as a first-line treatment for all hemangiomas with functional deficit and/or disfigurement according to a specific treatment protocol, published earlier,5 that involves pretreatment cardiac workup and a titrated dose of propranolol to 1 mg/kg three times daily. In our series, all periocular hemangiomas are managed in a multidisciplinary setup, with propranolol as the first-line therapy.
Although we agree with all the points raised in your article, we would like to suggest that β-blocking agents have an important role in the management of all hemangiomas, including periocular hemangiomas.
Anuj Mishra, M.R.C.S.
William J. M. Holmes, M.R.C.S.
Catherine Gorst, R.G.N., R.S.C.N.
Sehwang H. Liew, F.R.C.S.
Department of Plastic and Reconstructive Surgery
Alder Hey Children's Hospital
Liverpool, United Kingdom
1. Arneja JS, Mulliken JB. Resection of amblyogenic periocular hemangiomas: Indications and outcomes. Plast Reconstr Surg.
2. Leaute-Labreze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taib A. Propranolol for severe hemangiomas of infancy. N Engl J Med.
3. Buckmiller L, Dyamenahalli U, Richter GT. Propranolol for airway hemangioma: Case report of novel treatment. Laryngoscope
4. Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: Risks and recommendations. Pediatr Dermatol.
5. Holmes WJ, Mishra A, Gorst C, Liew SH. Propranolol as first-line treatment for infantile hemangiomas. Plast Reconstr Surg.
Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.
Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/.
We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.