PRSonally Speaking

Wednesday, March 26, 2014

Treatment of infantile haemangiomas with propranolol - clinical guidelines
 
At least twice a month, PRSonally Speaking posts full abstracts of interesting or potentially controversial articles from a future issue. This 'sneak preview' of a hot article is meant to give you some food for thought and provide you with topic for conversation among colleagues.
 
When the article is published in print with the April issue, it will be FREE for a period of Two Months, to help the conversation continue in the PRS community and beyond. So read the abstract, join the conversation and spread the word.
 
This week we present the introduction to "Treatment of infantile haemangiomas with propranolol - clinical guidelines" by Szychta et al.

Introduction. Infantile haemangioma (IH) is vascular tumour and requires treatment in lesions manifested by potentially dangerous symptoms. Several publications reported that involution of IH could be accelerated by propranolol, but used only invalidated subjective measures of assessment. We aimed to validate objectively the aesthetic results after propranolol treatment for IH, and to produce protocol of therapy, including optimal timing for introduction, pre-treatment preparation, dosage, frequency of visits, duration and patient safety.

Methods. For the non-randomized comparative cohort study we enrolled 60 patients treated with propranolol. Medical 2D photographs, taken pre- and post-treatment, were analyzed subjectively by three plastic surgery consultants and objectively with computer program. Aesthetic results were analyzed using the following parameters: subjective overall outcome, subjective colour fading and objective colour fading. Reliability of subjective and objective methods were quantified and compared, as described with accuracy and repeatability. Volumetric parameters were obtained from 3D scans taken pre- and post-treatment and analyzed objectively with computer program. Numerous patients' data were recorded from the medical notes.

Results. Our study proved high efficiency of propranolol in treatment of IH, as assessed with the objective measures for the first time. We outlined optimal protocol of treatment, including introduction, dosage, duration and cessation of therapy.

Conclusions. Propranolol is an effective, well tolerated and safe first-line treatment for proliferative haemangioma. Therapy should be commenced early, continued with the target dosage of 2mg/kg/day in 3 divided doses through proliferative phase of IH and stopped gradually.
 
The full article will be published with the April 2014 issue of PRS, and will be free online for non-subscribers. Until then, we hope this "sneak peek" will pique your interests and start a healthy, meaningful conversation.