Beta-blockers Versus Corticosteroids in the Treatment of Infantile Hemangioma: an Evidence-based Systematic Review

Overview

Journal World J Pediatr

Specialty Pediatrics

Date 2013 Aug 10

PMID 23929254

Citations 9

Authors

Shi-Qiong Xu

Ren-Bing Jia

Wei Zhang

Huang Zhu

Sheng-Fang Ge

Xian-Qun Fan

Affiliations

Soon will be listed here.

Abstract

Background: The efficacy and safety of beta-blockers versus corticosteroids in the treatment of infantile hemangiomas (IHs) is controversial. This study aimed to summarize evidence described in the literature and to assess the quality of studies involving beta-blockers and corticosteroids for the treatment of cutaneous IHs.

Methods: Comparative studies were collected from 15 online electronic databases, including OVID Medline, PubMed, ISI Web of Science, CENTRAL, CNKI, ChiCTR, JPCTR, CTRIndia, IranCTR, SLCTR, ISRCTRN, NLCTR, GCTR, ANCTR, ClinicalTrial. gov, and associated references. Studies without a control group were excluded, and the remaining studies were assessed by two reviewers independently using the Downs & Black scale for reported quality. The main areas assessed in the included studies were volume changes, overall improvement in appearance, eye function, and adverse events.

Results: Ten comparative studies were included with a total of 419 children. A meta-analysis was not performed due to the considerable heterogeneity across studies. Some evidence showed that beta-blockers are superior to steroids in reducing volume and improving the overall appearance of IHs, such as lightening of the color and flattening of the surface. Conclusions regarding improved eye function and adverse events were divided, and no consensus has been reached on the superiority of one treatment over another. No episodes of severe-onset asthma, hypotension, or bradycardia occurred in the beta-blocker treatment due to the rigorous exclusion of patients with contraindications.

Conclusions: Available studies indicate that beta-blockers are an alternative option to corticosteroids for IH treatment with respect to volume shrinkage and improvement in appearance. No evidence has shown a significant difference in improved eye function and adverse events between beta-blockers and corticosteroids in the treatment of IH; indeed, there is a lack of well-designed, high-quality randomized control trials.

Citing Articles

Anesthesia management of a patient with multiple facial hemangiomas: Sometimes less is more!.

Samagh N, Utkarsh , Sharma V, Grewal A J Anaesthesiol Clin Pharmacol. 2025; 40(4):711-712.

PMID: 39759042 PMC: 11694879. DOI: 10.4103/joacp.joacp_104_23.

Airway management of a patient with extensive upper airway hemangioma for total thyroidectomy.

Rajan S, Sasikumar N, Anand R, Paul J J Anaesthesiol Clin Pharmacol. 2024; 39(4):677-678.

PMID: 38269153 PMC: 10805187. DOI: 10.4103/joacp.joacp_167_22.

Oral Beta-blocker in Problematic Infantile Hemangioma.

AlHasan R, Arabiyat L, Ammar H, Louri N Plast Reconstr Surg Glob Open. 2021; 9(5):e3581.

PMID: 34881149 PMC: 8647869. DOI: 10.1097/GOX.0000000000003581.

Anesthetic management of a patient with face hemangioma: case report.

Onay M, Sanal Bas S, Ozdol I, Yelken B Braz J Anesthesiol. 2021; 71(2):171-174.

PMID: 33894859 PMC: 9373525. DOI: 10.1016/j.bjane.2021.02.019.

Beta Blockers in the Treatment of Periocular Infantile Hemangiomas: A Review.

Tran A, Choi C, Wester S Intern Med Rev (Wash D C). 2020; 2(9).

PMID: 32318646 PMC: 7172575. DOI: 10.18103/imr.v2i9.221.

References

Pope E, Chakkittakandiyil A, Lara-Corrales I, Maki E, Weinstein M . Expanding the therapeutic repertoire of infantile haemangiomas: cohort-blinded study of oral nadolol compared with propranolol. Br J Dermatol. 2012; 168(1):222-4. DOI: 10.1111/j.1365-2133.2012.11131.x. View

Rossler J, Schill T, Bahr A, Truckenmuller W, Noellke P, Niemeyer C . Propranolol for proliferating infantile haemangioma is superior to corticosteroid therapy--a retrospective, single centre study. J Eur Acad Dermatol Venereol. 2011; 26(9):1173-5. DOI: 10.1111/j.1468-3083.2011.04314.x. View

Haggstrom A, Drolet B, Baselga E, Chamlin S, Garzon M, Horii K . Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr. 2007; 150(3):291-4. DOI: 10.1016/j.jpeds.2006.12.003. View

Lawley L, Siegfried E, Todd J . Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol. 2009; 26(5):610-4. DOI: 10.1111/j.1525-1470.2009.00975.x. View

Stang A . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010; 25(9):603-5. DOI: 10.1007/s10654-010-9491-z. View

Georgountzou A, Karavitakis E, Klimentopoulou A, Xaidara A, Kakourou T . Propranolol treatment for severe infantile hemangiomas: a single-centre 3-year experience. Acta Paediatr. 2012; 101(10):e469-74. DOI: 10.1111/j.1651-2227.2012.02783.x. View

Semkova K, Kazandjieva J . Topical timolol maleate for treatment of infantile haemangiomas: preliminary results of a prospective study. Clin Exp Dermatol. 2012; 38(2):143-6. DOI: 10.1111/j.1365-2230.2012.04425.x. View

Kilcline C, Frieden I . Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol. 2008; 25(2):168-73. DOI: 10.1111/j.1525-1470.2008.00626.x. View

Bertrand J, McCuaig C, Dubois J, Hatami A, Ondrejchak S, Powell J . Propranolol versus prednisone in the treatment of infantile hemangiomas: a retrospective comparative study. Pediatr Dermatol. 2011; 28(6):649-654. DOI: 10.1111/j.1525-1470.2011.01551.x. View

10.

Hogeling M, Adams S, Wargon O . A randomized controlled trial of propranolol for infantile hemangiomas. Pediatrics. 2011; 128(2):e259-66. DOI: 10.1542/peds.2010-0029. View

11.

Hermans D, van Beynum I, Kool L, van de Kerkhof P, Wijnen M, van der Vleuten C . Propranolol, a very promising treatment for ulceration in infantile hemangiomas: a study of 20 cases with matched historical controls. J Am Acad Dermatol. 2011; 64(5):833-8. DOI: 10.1016/j.jaad.2011.01.025. View

12.

Bennett M, Fleischer Jr A, Chamlin S, Frieden I . Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation. Arch Dermatol. 2001; 137(9):1208-13. DOI: 10.1001/archderm.137.9.1208. View

13.

Talaat A, Elbasiouny M, Elgendy D, Elwakil T . Propranolol treatment of infantile hemangioma: clinical and radiologic evaluations. J Pediatr Surg. 2012; 47(4):707-14. DOI: 10.1016/j.jpedsurg.2011.10.058. View

14.

Batta K, Goodyear H, Moss C, Williams H, Hiller L, Waters R . Randomised controlled study of early pulsed dye laser treatment of uncomplicated childhood haemangiomas: results of a 1-year analysis. Lancet. 2002; 360(9332):521-7. DOI: 10.1016/S0140-6736(02)09741-6. View

15.

Downs S, Black N . The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998; 52(6):377-84. PMC: 1756728. DOI: 10.1136/jech.52.6.377. View

16.

Jiang C, Hu X, Ma G, Chen D, Jin Y, Chen H . A prospective self-controlled phase II study of imiquimod 5% cream in the treatment of infantile hemangioma. Pediatr Dermatol. 2011; 28(3):259-66. DOI: 10.1111/j.1525-1470.2011.01520.x. View

17.

Blei F . Oral prednisolone for infantile hemangioma: efficacy and safety using a standardized treatment protocol. Plast Reconstr Surg. 2012; 129(5):840e-841e. DOI: 10.1097/PRS.0b013e31824a61a7. View

18.

Weissenstein A, Straeter A, Villalon G, Bittmann S . Topical timolol for small infantile hemangioma: a new therapy option. Turk J Pediatr. 2012; 54(2):156-8. View

19.

Saint-Jean M, Leaute-Labreze C, Mazereeuw-Hautier J, Bodak N, Hamel-Teillac D, Kupfer-Bessaguet I . Propranolol for treatment of ulcerated infantile hemangiomas. J Am Acad Dermatol. 2011; 64(5):827-32. DOI: 10.1016/j.jaad.2010.12.040. View

20.

Chakkittakandiyil A, Phillips R, Frieden I, Siegfried E, Lara-Corrales I, Lam J . Timolol maleate 0.5% or 0.1% gel-forming solution for infantile hemangiomas: a retrospective, multicenter, cohort study. Pediatr Dermatol. 2011; 29(1):28-31. DOI: 10.1111/j.1525-1470.2011.01664.x. View