Duration 5min, Q&A 3min
Treatment of Periocular Capillary Haemangioma with Oral Propranolol on an Outpatient Basis
To observe the effect of oral propranolol, a non-selective adrenergic beta blocker, in periocular hemangioma on an outpatient basis.
Eight patients between the age of 4 months to 16 months were enrolled. Among them 5 were female and 3 were male. Four patients had haemangioma on upper lid, 3 had on lower lid and 1 had on medial canthus. At the time of commencement of treatment, five patients were in their infancy with proliferative phase of their lesion. The rest 3 patients were older than 12 months and they received treatment during the resting phase of their lesion.
This is a retrospective observational case series. All patients underwent thorough systemic examination by paediatrician before commencement of treatment with oral propranolol, but were not screened via electrocardiography or echocardiography. All the patients were treated on an outpatient basis. The initial dose of oral propranolol was 1mg/kg/day in two divided doses which was increased to 2mg/kg/day after 10 days. Thereafter, patients were reviewed 4 weekly and in every visit heart rate was recorded. Parents were counseled about adverse effects of propranolol, particularly hypoglycemia and were advised to feed their babies frequently in the first 3 hours after giving the dose. In all cases photographic documentation was kept before starting treatment and in every visit for comparison. Treatment was continued till the response reached to the plateau when no significant change in color and size was noticed in subsequent two visits. At this point, dose was tapered over 2-3 weeks.
Results and Conclusion
All patients showed noticeable improvement in physical appearance and size of their lesion after treatment with oral propranolol. The surface area was reduced completely in 2 patients and > 50% in 3 patients who had commencement of treatment in the proliferative phase of their lesion. The rest 3 patients who were older than 12 months showed less than 50% reduction in surface area. The lesion became softened and lightened in color in all patients. The mean duration of treatment was 5.3 months (range 4.5 to 7.3 months). There were no significant adverse effects to discontinue the treatment.
Oral Propranolol is an effective first line therapy for capillary haemangioma in children and can produce remarkable outcome if treated earlier. In published articles so far, no significant adverse effect of using propanolol in infants has been documented. Therefore, oral propanolol can be used safely in infants for treating capillary haemangioma on an outpatient basis.
[ Keyword ]
Capillary Haemangioma / Propranolol
[ Conflict of Interest ]