Hemangioma medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hemangioma}} | {{Hemangioma}} | ||
{{CMG}};{{AE}} {{NM}} | {{CMG}};{{AE}} {{NM}}{{ADS}} | ||
==Overview== | ==Overview== | ||
The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically. | The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*Medical and surgical options are available for the treatment of “problematic” hemangiomas.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> | * Medical and surgical options are available for the treatment of “problematic” hemangiomas.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref><ref name="epidemiology">Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref> | ||
*Medical management includes one or more systemic therapies. | * Medical management includes one or more systemic therapies. | ||
*For massive and life-threatening disease:<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> | * For massive and life-threatening disease:<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> | ||
**[[Corticosteroids]] | |||
** [[Interferon]] | |||
** [[Vincristine]] | |||
* These agents have also been used for:<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> | |||
** Multifocal disease | |||
** Visceral involvement | |||
** Segmental distribution | |||
** Airway obstruction | |||
** Periorbital lesions | |||
===Propranolol=== | ===Propranolol=== | ||
*A paradigm shift has occurred regarding the treatment of hemangiomas over the past few years.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> | *A paradigm shift has occurred regarding the treatment of hemangiomas over the past few years.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> | ||
*Propranolol, a nonselective [[Β-2 adrenergic receptor|β-adrenergic antagonist]], was serendipitous discovered to cause regression of proliferating hemangiomas in newborns receiving treatment for cardiovascular disease. | |||
*Propranolol, a nonselective β-adrenergic antagonist, was | *Numerous studies demonstrating the success of [[propranolol]] for shrinking hemangiomas | ||
*Numerous studies demonstrating the success of propranolol for shrinking hemangiomas | *Over ninety percent of patients have dramatic reduction in the size of their hemangiomas as early as 1-2 weeks following the first dose of [[propranolol]]. | ||
*Over ninety percent of patients have dramatic reduction in the size of their hemangiomas as early as 1-2 weeks following the first dose of propranolol. | *Dosing for [[propranolol]] in treating hemangiomas is recommended to be 2-3 mg/kg separated into two or three-times-a-day regimens. | ||
*Dosing for propranolol in treating hemangiomas is recommended to be 2-3 mg/kg separated into two or three-times-a-day regimens. | |||
*These doses are dramatically below the concentration employed for cardiovascular conditions in children.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> | *These doses are dramatically below the concentration employed for cardiovascular conditions in children.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref> | ||
'''Pediatric/Infantile hemangioma in proliferative phase:''' | |||
*Oral regimen | |||
** Preferred regimen (1): [[Propranolol]] 0.5 mL/kg PO q12h for 7 days; | |||
*** [[Propranolol]] 0.3 mL/kg PO q12h for 7 days; | |||
*** [[Propranolol]] 0.4 mL/kg PO q12h for 6 months | |||
'''Beyond proliferative phase''' | |||
*Oral regimen | |||
** Preferred regimen (1): [[Propranolol]] 1.5-3 mg/kg/day PO for 8 months.<ref name="pmid21362031">{{cite journal |vauthors=Zvulunov A, McCuaig C, Frieden IJ, Mancini AJ, Puttgen KB, Dohil M, Fischer G, Powell J, Cohen B, Ben Amitai D |title=Oral propranolol therapy for infantile hemangiomas beyond the proliferation phase: a multicenter retrospective study |journal=Pediatr Dermatol |volume=28 |issue=2 |pages=94–8 |date=2011 |pmid=21362031 |doi=10.1111/j.1525-1470.2010.01379.x |url=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Disease]] | [[Category:Disease]] | ||
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[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Vascular medicine]] | |||
[[Category:Surgery]] | |||
Latest revision as of 22:01, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]Amandeep Singh M.D.[3]
Overview
The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically.
Medical Therapy
- Medical and surgical options are available for the treatment of “problematic” hemangiomas.[1][2]
- Medical management includes one or more systemic therapies.
- For massive and life-threatening disease:[1]
- These agents have also been used for:[1]
- Multifocal disease
- Visceral involvement
- Segmental distribution
- Airway obstruction
- Periorbital lesions
Propranolol
- A paradigm shift has occurred regarding the treatment of hemangiomas over the past few years.[1]
- Propranolol, a nonselective β-adrenergic antagonist, was serendipitous discovered to cause regression of proliferating hemangiomas in newborns receiving treatment for cardiovascular disease.
- Numerous studies demonstrating the success of propranolol for shrinking hemangiomas
- Over ninety percent of patients have dramatic reduction in the size of their hemangiomas as early as 1-2 weeks following the first dose of propranolol.
- Dosing for propranolol in treating hemangiomas is recommended to be 2-3 mg/kg separated into two or three-times-a-day regimens.
- These doses are dramatically below the concentration employed for cardiovascular conditions in children.[1]
Pediatric/Infantile hemangioma in proliferative phase:
- Oral regimen
- Preferred regimen (1): Propranolol 0.5 mL/kg PO q12h for 7 days;
- Propranolol 0.3 mL/kg PO q12h for 7 days;
- Propranolol 0.4 mL/kg PO q12h for 6 months
- Preferred regimen (1): Propranolol 0.5 mL/kg PO q12h for 7 days;
Beyond proliferative phase
- Oral regimen
- Preferred regimen (1): Propranolol 1.5-3 mg/kg/day PO for 8 months.[3]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Richter, Gresham T.; Friedman, Adva B. (2012). "Hemangiomas and Vascular Malformations: Current Theory and Management". International Journal of Pediatrics. 2012: 1–10. doi:10.1155/2012/645678. ISSN 1687-9740.
- ↑ Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#
- ↑ Zvulunov A, McCuaig C, Frieden IJ, Mancini AJ, Puttgen KB, Dohil M, Fischer G, Powell J, Cohen B, Ben Amitai D (2011). "Oral propranolol therapy for infantile hemangiomas beyond the proliferation phase: a multicenter retrospective study". Pediatr Dermatol. 28 (2): 94–8. doi:10.1111/j.1525-1470.2010.01379.x. PMID 21362031.