Propranolol en el tratamiento de los hemangiomas: una alternativa terapéutica

Introduccion: los hemangiomas son los tumores benignos mas frecuentes de la infancia. Generalmente involucionan espontaneamente despues del ano. Un porcentaje pequeno requiere tratamiento debido a complicaciones. Recientemente se ha comunicado beneficio del tratamiento con propranolol. Objetivo: describir la experiencia de tratamiento con propranolol en 6 ninos con hemangiomas infantiles (HI) en dos centros asistenciales de Montevideo en el periodo 1/9/2010 – 31/12/2013. Metodologia: se incluyeron los menores de 15 anos portadores de hemangiomas asistidos en el Centro Hospitalario Pereira Rossell y en la Asociacion Espanola tratados con propranolol. En todos los casos se realizo evaluacion cardiologica previa. Se excluyeron aquellos con contraindicaciones absolutas al farmaco. En todos los casos se solicito, previo al tratamiento, consentimiento informado. Se describe las caracteristicas clinicas de los ninos y la evolucion. Resultados: se incluyeron 6 ninos (5 ninas y un varon); rango 1 mes y 21 dias a 20 meses. Las topografias fueron: labio superior con compromiso de narina 2, mejilla izquierda 1, raiz nasal e intraorbitario 1, intraocular 1, multiple 1. En todos los casos la respuesta fue favorable con disminucion progresiva de las lesiones en los primeros meses de tratamiento. Ninguno presento complicaciones. Discusion: esta es la primera comunicacion de una serie de ninos con hemangiomas tratados con propranolol en Uruguay. A pesar del escaso numero de pacientes, se observo beneficio terapeutico sin complicaciones. El propranolol debe considerarse como una alternativa terapeutica al tratamiento con glucocorticoides sistemicos, cuya administracion prolongada se asocia con serios efectos adversos. (AU) Introduction: hemangiomas are the most common benign tumors of childhood. They usually regress spontaneously after the year of life. A small percentage require treatment due to complications. Recently it has been reported the benefit of treatment with propranolol. Objective: describe the experience of treatment with propranolol in 6 children with infantile hemangiomas (HI) in two centers of Montevideo in the period 1/9/2010-31/12/2013.Methodology: included infants under de age of 15 carriers of hemangiomas assisted in the Pereira Rossell hospital and the Spanish Association treated with propranolol. Cardiological assessment was previously performed in all cases. Those with absolute contraindications to the drug were excluded. Informed consent was requested prior to the treatment in all cases. The clinical features of children and evolution are described. Results: 6 children were included (5 girls and a male); range 1 month and 21 days to 20 months. The surveys were: upper lip with commitment of nostril 2, left cheek 1, nasal root and intraorbitary 1, intraocular 1, multiple 1. In all cases the response was favorable with progressive decrease in injuries in the first month of treatment. None of the patients presented complications. Discussion: this is the first communication of a series of children with hemangioma treated with propranolol in Uruguay. Despite the small number of patients therapeutic benefit without complications was observed. Propranolol should be considered as a therapeutic alternative to treatment with systemic glucocorticoids whose prolonged administration is associated with serious adverse effects. (AU)