Delayed-onset of multiple cutaneous infantile hemangiomas due to propranolol: a case report

Pediatrics. 2015 Apr;135(4):e1064-6. doi: 10.1542/peds.2014-3053. Epub 2015 Mar 16.

Abstract

Infantile hemangiomas are the most common vascular tumors in childhood. In view of its proven effectiveness in such cases, propranolol is the drug of choice. We present the case of a male infant who started treatment with propranolol shortly after birth due to heart disease. After 7 months, when the patient had suffered various respiratory exacerbations, this treatment was suspended. One week later, multiple skin lesions (ie, multifocal infantile hemangiomas) began to appear, with no extracutaneous involvement. It was decided to resume treatment with propranolol, although at lower doses than before, and the skin lesions improved rapidly, with some disappearing completely. Treatment was definitively withdrawn at age 16 months, with only slight recurrence of the lesions. The case described is of multifocal infantile hemangiomas without extracutaneous involvement appearing beyond the neonatal period after treatment with propranolol beginning in the first days of life. The details of the case support the hypothesis that this drug is not only therapeutic but also plays a prophylactic role against infantile hemangiomas. In turn, this supports the recent proposal that this drug may be useful in preventing the growth and spread of tumors with high angiogenic potential. It is postulated that the inhibition of β-adrenergic receptors is associated with multiple intracellular processes related to the progression and metastasis of different tumors.

Keywords: cancer; hemangiomas; propranolol.

Publication types

  • Case Reports

MeSH terms

  • Dose-Response Relationship, Drug
  • Heart Defects, Congenital / drug therapy*
  • Hemangioma / chemically induced*
  • Hemangioma / diagnosis
  • Hemangioma / drug therapy
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Neoplasms, Multiple Primary / chemically induced*
  • Neoplasms, Multiple Primary / diagnosis
  • Neoplasms, Multiple Primary / drug therapy
  • Propranolol / adverse effects*
  • Propranolol / therapeutic use
  • Recurrence
  • Skin Neoplasms / chemically induced*
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / drug therapy
  • Substance Withdrawal Syndrome / diagnosis*
  • Substance Withdrawal Syndrome / drug therapy

Substances

  • Propranolol