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Treatment of Infantile Hemangiomas with Propranolol: Clinical Guidelines

Szychta, Pawel M.D., Ph.D.; Stewart, Ken M.D.; Anderson, Will M.D.


In the April 2014 Pediatric/Craniofacial article entitled “Treatment of Infantile Hemangiomas with Propranolol: Clinical Guidelines” by Szychta et al. (Plast Reconstr Surg. 2014;133:852–862), the affiliation footnote is incorrect. The affiliation footnote should have read as follows (correction in italics): “From the Department of Plastic and Reconstructive Surgery, The Royal Hospital of Sick Children (Edinburgh, United Kingdom); and the Department of Oncological Surgery and Breast Diseases, Mother's Poland Memorial Hospital & Research Institute (Lodz, Poland).”

Plastic and Reconstructive Surgery. 134(1):168, July 2014.

Plastic and Reconstructive Surgery: April 2014 - Volume 133 - Issue 4 - p 852–862
doi: 10.1097/PRS.0000000000000007
Pediatric/Craniofacial: Original Articles
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Background: Infantile hemangioma is a vascular tumor and requires treatment in lesions manifested by potentially dangerous symptoms. Several publications have reported that involution of infantile hemangioma could be accelerated by propranolol but have used only invalidated subjective measures of assessment. The authors aimed to objectively validate the aesthetic results after propranolol treatment for infantile hemangioma, and to produce a therapy protocol, including optimal timing for introduction, pretreatment preparation, dosage, frequency of visits, duration, and patient safety.

Methods: For the nonrandomized comparative cohort study, the authors enrolled 60 patients treated with propranolol. Medical two-dimensional photographs, taken before and after treatment, were subjectively analyzed by three plastic surgery consultants and objectively analyzed with a computer program. Aesthetic results were analyzed using the following parameters: subjective overall outcome, subjective color fading, and objective color fading. Reliability of subjective and objective methods was quantified and compared, as described with accuracy and repeatability. Volumetric parameters were obtained from three-dimensional scans taken before and after treatment and objectively analyzed with a computer program. Numerous patients’ data were recorded from the medical notes.

Results: This study proved high efficiency of propranolol in treatment of infantile hemangioma, as assessed with the objective measures for the first time. The authors outlined an optimal treatment protocol, including introduction, dosage, duration, and cessation of therapy.

Conclusions: Propranolol is an effective, well-tolerated, and safe first-line treatment for proliferative hemangioma. Therapy should begin early, continue with the target dosage of 2 mg/kg/day in three divided doses through the proliferative phase of infantile hemangioma, and be stopped gradually.


Edinburgh, United Kingdom

From the Department of Plastic and Reconstructive Surgery, The Royal Hospital of Sick Children.

Received for publication August 6, 2013; accepted October 10, 2013.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Will Anderson, M.D., Department of Plastic and Reconstructive Surgery, Royal Hospital of Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, United Kingdom,

©2014American Society of Plastic Surgeons