I read with great interest the special report by Drs. Itinteang et al. entitled “Pharmacologic Therapies for Infantile Hemangioma: Is There a Rational Basis?”1 The authors are to be congratulated for achieving a true advance toward understanding the pathogenesis of hemangioma and its response to pharmacologic therapy; recently, practitioners treating hemangioma have been intrigued by the favorable clinical response to propranolol (including our group2). However, until now, a model to describe a basis for its efficacy has been elusive. Their translational explanations as to how the basic science correlates with the pharmacology and physiology are most insightful. Furthermore, I had the pleasure of listening to Dr. Tan's presentation this past May at the 16th Congress of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery, in 2011 in Vancouver, British Columbia, and without hesitation, this dissertation can be considered a highlight of the confederation's proceedings.
Some questions are certain to stem from one's analysis of this article, specifically, pertaining to the response of hemangiomas to the different pharmacologic modalities. Why do certain tumors respond to corticosteroid and/or β-blocker therapy whereas others do not? Why does congenital hemangioma (i.e., rapidly involuting congenital hemangioma/noninvoluting congenital hemangioma) seldom respond to pharmacologic intervention? Should there be a similar response using angiotensin-converting enzyme inhibitors or even combined therapies that target the renin-angiotensin system? An illustration indicating the purported mechanism of action of the various pharmacologic modalities would be valuable.
Clearly, scientific advances are often met by more questions than answers; however, these authors are to be congratulated on their strong body of work on this subject. I welcome their future contributions to the study of this most interesting tumor.
Jugpal S. Arneja, M.D.
Division of Plastic Surgery, University of British Columbia, and, British Columbia Children's Hospital, Vancouver, British Columbia, Canada, [email protected]
1. Itinteang T, Withers AH, Leadbitter P, Day DJ, Tan ST. Pharmacologic therapies for infantile hemangioma: Is there a rational basis? Plast Reconstr Surg. 2011;128:499–507.
2. Arneja JS, Pappas PN, Shwayder TA, et al.. Management of complicated facial hemangiomas with beta-blocker (propranolol) therapy. Plast Reconstr Surg. 2010;126:889–895.
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