Hemangioma medical therapy: Difference between revisions
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* 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]] | **[[Corticosteroids]] | ||
** [[Interferon]] | ** [[Interferon]] | ||
** [[Vincristine]] | ** [[Vincristine]] | ||
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===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-adrenergic antagonist, was | *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. | ||
*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:''' | '''Pediatric/Infantile hemangioma in proliferative phase:''' | ||
Revision as of 23:15, 27 August 2019
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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.