Plastic & Reconstructive Surgery:
Beta-Blocking Agent for Treatment ofInfantile Hemangioma
Bigorre, Michele M.D.; Van Kien, Aurelie Khau M.D.; Valette, Huguette M.D.
CHU Montpellier; Department of Orthopedic and Plastic Pediatric Surgery; Lapeyronie Hospital; Montpellier, France (Bigorre)
CHU Montpellier; Department of Vascular Medicine; Saint Eloi Hospital; Montpellier, France (Khau Van Kien)
CHU Montpellier; Pediatric Department; Arnaud de Villeuneuve Hospital; Montpellier, France (Valette)
Correspondence to Dr. Bigorre; CHU Montpellier; Department of Orthopedic and Plastic Pediatric Surgery; Lapeyronie Hospital; 371 Gaston Giraud Street; Montpellier 34295, France; email@example.com
Infantile hemangioma is a benign vascular tumor that involutes spontaneously by 5 to 7 years of age. Approximately 10 percent of these tumors are problematic.
For function- and life-threatening hemangiomas, the first-line medical treatment is corticosteroid, followed by vincristine or interferon.1–3 Corticosteroid results in regression in 40 percent, stabilization in 30 percent, and no response in 30 percent of cases. Corticosteroid complications have been well described in the literature; all disappear after the treatment is stopped.4 The effect on blood pressure has not been studied. We report the effect of acebutolol (β-blocking agent), 10 mg/kg/day, in four infants with proliferating phase hemangioma.
The first patient had a parotid hemangioma diagnosed at 6 weeks of age. Initially, he was treated with corticosteroid (prednisolone, 2 mg/kg/day) and developed high blood pressure that necessitated acebutolol given at 10 mg/kg/day. The effect of this drug on the hemangioma was immediately visible; the color and bulk decreased. The corticosteroid was tapered progressively until the child was 5 months old. We attempted to stop acebutolol at 4 months but noticed that the hemangioma swelled each time we discontinued the drug. Acebutolol was maintained until the age of 1 year, when the hemangioma stabilized.
We treated two other 2-month-old patients with hemifacial hemangioma. One of these had ocular occlusion. Corticosteroid (prednisolone, 2 mg/kg/day) was given immediately. Because there was no response after 15 days of treatment, we began acebutolol at 10 mg/kg/day. The corticosteroid dosage was decreased slowly over 3 months and acebutolol was stopped at 1 year of age. The hemangioma regressed and the ocular occlusion improved during administration and after discontinuation of the corticosteroid (Fig. 1).
The fourth child was 13 months old and had a perineal hemangioma complicated by cutaneous ulcerations. We did not give corticosteroids; instead, acebutolol (10 mg/kg/day) was given, and we observed decreased vascularity and thickness and healing of cutaneous lesions over 1 month. He is always treated by acebutolol.
Acebutolol is a selective β-adrenergic receptor–blocking agent. We propose that it reduces blood flow to the hemangioma either by blocking the vasodilator response to β-adrenergic stimulation or by diminishing heart rate.
Acebutolol was administered to treat corticosteroid hypertension and induced an effectiveness on the proliferating phase hemangioma. The dose given was always minimal for hypertension. We had no complications during this treatment and no hypotension. The only contraindications were bronchial asthma and cardiac insufficiency. We plan a prospective clinical and Doppler sonographic study (corticosteroid versus acebutolol) to evaluate the possible effectiveness of acebutolol.
Michele Bigorre, M.D.
Department of Orthopedic and Plastic Pediatric Surgery
Aurelie Khau Van Kien, M.D.
Department of Vascular Medicine
Saint Eloi Hospital
Huguette Valette, M.D.
Arnaud de Villeuneuve Hospital
1. Boon LM, Bataille AC, Bernier V, Vermylen C, Verellen G. Medical treatment of juvenile hemangiomas (in French). Ann Chir Plast Esthet.
2. Enjolras O, Brevière GM, Roger G, et al. Vincristine treatment for function- and life-threatening infantile hemangioma (in French). Arch Pediatr.
3. Ezekowitz RA, Mulliken JB, Folkman J. Interferon alfa-2a therapy for life-threatening hemangiomas of infancy. N Engl J Med.
4. Boon LM, MacDonald DM, Mulliken JB. Complications of systemic corticosteroid therapy for problematic hemangioma. Plast Reconstr Surg.
Viewpoints, pertaining to issues of general interest, are welcome, even if they are not related to items previously published. Viewpoints may present unique techniques, brief technology updates, technical notes, and so on. Viewpoints will be published on a space-available basis because they are typically less timesensitive than Letters and other types of articles. Please note the following criteria:
* Text—maximum of 500 words (not including references)
* References—maximum of five
* Authors—no more than five
* Figures/Tables—no more than two figures and/or one table
Authors will be listed in the order in which they appear in the submission. Viewpoints should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/. We strongly encourage authors to submit figures in color.
We reserve the right to edit Viewpoints to meet requirements of space and format. Any financial interests relevant to the content must be disclosed. Submission of a Viewpoint constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the Journal and in any other form or medium.
The views, opinions, and conclusions expressed in the Viewpoints 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.
©2009American Society of Plastic Surgeons