Novel treatment for infantile hemangiomas.

Evidence Oral propranolol • In an RCT (40 children, aged 9 weeks to 5 years, followed for 6 months),1 2 mg/kg of propranolol (divided 3 times daily) stopped IH growth by week 4 for all children and reduced IH volume at all weeks compared with placebo (eg, -48.5% vs 17.9% in week 12, P = .03). No significant hypotension, hypoglycemia, or bradycardia were reported. • In a systematic review of 40 observational studies and the 1 RCT1 (1264 children, mean age 6.6 months, treated for 6.4 months),2 98% of treated children showed at least some improvement, and serious side effects were rare. Topical timolol • In an RCT (41 children, median 9 weeks old),3 at 20 to 24 weeks, significantly (P ≤ .02) more treated IHs decreased in size by more than 5% (vs normal size increase at this age) compared with placebo (number needed to treat [NNT] = 3). Limitations included small numbers. • In a prospective clinical study (124 children younger than 12 months),4 at 4 months, significantly (P < .05) more IHs stopped growing or became smaller (92% vs 34%, NNT = 2) in the timolol group than in the observational group. No serious adverse events were reported. • Smaller retrospective cohort and prospective clinical studies had similar findings.5-9