MAR 05, 2009
This brief correspondence article reports on the great success of using systemic propranolol to treat capillary hemangiomas of infancy, perhaps the most impressive nonsurgical therapy introduced to the ophthalmic plastic surgery field in recent years. As with many great ideas in medicine, it was an accidental finding that capillary hemangiomas shrunk after patients were treated with systemic propranolol for related high cardiac output.
The authors included preliminary data from 11 children. In just 24 hours after treatment all patients improved as the hemangiomas changed from intense red to purple that was accompanied with a palpable softening of the lesion. The hemangiomas continued to improve until they were nearly flat with residual skin telangiectasias. Ultrasound exams were conducted in some patients and revealed objective regression in thickness associated with an increase in the resistive index of vascularization of the hemangioma.
Potential explanations offered by the authors for propranolol's effects on infantile capillary hemangiomas include vasoconstriction, decreased VEGF and bFGF gene expression through the down-regulation of the RAF-mitogen-activated protein kinase pathway and the triggering of apoptosis of capillary endothelial cells. Longer follow-up periods and controlled studies will better delineate propranolol's effects, including its possible synergistic effect with systemic steroids.
Drs. Taban and Goldberg have no financial interests to disclose.