Share this article on:

Propranolol as First-Line Treatment for Infantile Hemangiomas

Holmes, Will J. M. M.R.C.S.; Mishra, Anuj M.R.C.S.; Gorst, Cath R.G.N., R.S.C.N.; Liew, Se-Hwang F.R.C.S.

Plastic and Reconstructive Surgery: January 2010 - Volume 125 - Issue 1 - p 420-421
doi: 10.1097/PRS.0b013e3181c2a731

Department of Plastic and Reconstructive Surgery; Alder Hey Children's Hospital; Liverpool, United Kingdom

Correspondence to Dr. Holmes; Department of Plastic and Reconstructive Surgery; Alder Hey Children's Hospital; Eaton Road; Liverpool, United Kingdom;

Back to Top | Article Outline


We read with great interest the article on the classification of vascular anomalies and the comprehensive treatment of hemangiomas.1 We are all too aware of the difficulties of treating hemangiomas, such as the timing and duration of intervention, and the inadequacy of conventional therapies.

The article clearly demonstrates the side effects of the pharmacologic treatments for hemangiomas and the need for newer treatment options. Recently, a number of cases have been reported of the efficacy of β-blockers in the treatment of hemangioma.2,3

As part of a larger study, we have used propranolol in a total of 15 patients. So far, we have observed signs of rapid involution of hemangioma within the first week of treatment in all patients (Fig. 1). The response rate is faster than those we have seen when corticosteroids are used. In addition to stopping the proliferation of hemangiomas, propranolol also causes rapid involution within a short period. We now offer propranolol as a first-line treatment to all rapidly proliferating hemangiomas with functional deficit and/or disfigurement. We have developed a treatment protocol in conjunction with the cardiologist that involves pretreatment cardiac workup and an in-hospital titration of propranolol up to 1 mg/kg three times per day.4 So far, we have not needed to increase the dosage to more than 1 mg/kg three times per day.

Fig. 1.

Fig. 1.

All patients have responded well to treatment, with no side effects. Although we agree with all the points raised in the thorough article by Burns et al., we would like to suggest that β-blocking agents have an important role in the management of infantile hemangioma.

Will J. M. Holmes, M.R.C.S.

Anuj Mishra, M.R.C.S.

Cath Gorst, R.G.N., R.S.C.N.

Se-Hwang Liew, F.R.C.S.

Department of Plastic and Reconstructive Surgery

Alder Hey Children's Hospital

Liverpool, United Kingdom

Back to Top | Article Outline


1. Burns AJ, Navarro JA, Cooner RD. Classification of vascular anomalies and the comprehensive treatment of hemangiomas. Plast Reconstr Surg. 2009;124(1 Suppl.):69e–81e.
2. Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358:2649–2651.
3. Bigorre M, Van Kien AK, Valette H. Beta-blocking agent for treatment of infantile hemangioma. Plast Reconstr Surg. 2009;123:195e–196e.
4. Siegfried EC, Keenan WJ, Al-Jureidini S. More on propranolol for hemangioma of infancy. N Engl J Med. 2008;359:2846–2847.
Back to Top | Article Outline

Section Description

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

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.

©2010American Society of Plastic Surgeons