Authors:
Pristine W. Lee, MD, Division of Dermatology, University of California, San Diego, San Diego, CA and Lawrence F. Eichenfield, MD, Rady Children's Hospital, University of California, San Diego, Departments of Pediatrics and Medicine (Dermatology), San Diego, California.

Introduction

The 34^th Annual Meeting of the Society for Pediatric Dermatology (SPD) was held July 9 – 12, 2008, at the Snowbird Ski and Summer Resort in Snowbird, Utah. This year, there were a number of outstanding presentations, posters and forum discussions. This brief synopsis will highlight a few of these excellent presentations and provide a glimpse into the broad expanse of topics discussed.,

A Well Known Medicine, a Novel Use - Propranolol Therapy for Hemangiomas

Many hemangiomas follow a benign, self-resolving course, but some can cause physical deformity and pain, lead to loss of function (e.g., vision) or become life threatening. Current therapeutic options include oral corticosteroids or other systemic agents such as vincristine or interferon, but these therapies carry significant risks.¹ A new emerging therapy for hemangiomas is propranolol. In a recent publication, Léauté-Labrèze et al reported a series of 11 patients with large, severe hemangiomas of the head and neck treated with propranolol.² Four of the patients had failed prior corticosteroid therapy, but all 11 patients responded to propranolol with significant regression of the lesions. In addition, these patients tolerated the medication well, without cardiac side effects such as bradycardia or hypotension.

At this years' meeting, Dr. Eulalia Baselga, MD, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain,³ shared her successful implementation of propranolol as a treatment modality. The 5 cases, ages ranging from 2-11 months, had extensive hemangiomas of the head and neck and were enrolled in the experimental study under compassionate use guidelines. Represented within this group were hemangiomas with retrobulbar extension, corneal compression, physical closing of the eye, involvement of the laryngeal wall, and large masses with persistent ulceration and pain.  Four-of-five patients had failed oral corticosteroid treatment with lesions continuing to progress. The addition of laser therapy was not successful in the ulcerated lesion. All the patients were started on propranolol doses ranging from 1.5-2 mg/kg/day, with stable use of corticosteroids if applicable. At the time of follow up, there was significant improvement – substantial reduction in size and volume, regression from deeper involvement and healing of ulcerations. With the reported doses, there were no incidents of hypotension or bradycardia and the patients were able to taper their corticosteroid doses.

Potential mechanisms of action for propranolol have been proposed, including vasoconstriction, effects on angiogenic factors such as VEGF or β-FGF, or the induction of endothelial cell apoptosis.² However, further studies remain to elucidate the true mechanism, to assess its efficacy and safety relative to other medications and to establish guidelines for appropriate use of propranolol.