Nd:YAG 1064-nm laser for residual infantile hemangioma after propranolol treatment
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Abstract:
Abstract Infantile hemangiomas (IH) are common benign tumors of infancy. Most IH involute, either spontaneously, or secondary to pharmacological treatment with systemic propranolol. Propranolol treatment mostly leads to regression of hemangiomas with satisfactory aesthetic results, but unfortunately not in all cases. To assess the safety and efficacy of long pulsed Nd:YAG 1064 nm laser in treating patients with residual infantile hemangioma after systemic propranolol treatment. This is an open-label prospective cohort study. 30 patients with focal residual IH that had sub-optimal responses to systemic propranolol treatment were enrolled in the study. The patients were treated with 1 to 3 sessions with long pulsed Nd:YAG 1064 nm laser. The maximal response of the IH was assessed using a 4-point scale evaluation scale system. Of the 30 patients enrolled, 18 patients exhibited a great response (> 76% improvement), 10 patients had a good response (> 51–75% improvement), while only 2 patients showed a moderate response (< 50% improvement) to the treatment. No patients had an unsatisfactory response. No serious side effects were observed, and only minor side effects were reported. The treatment with long pulsed Nd:YAG 1064 nm laser for residual IH, which were resistant to systemic propranolol treatment, is safe and effective. Thus, we suggest its use as a second-line treatment for patients with sub-optimal aesthetic results following systemic propranolol.Keywords:
Infantile hemangioma
Laser Treatment
Nd:YAG laser
Background: Hemangioma is the most common vascular tumor in infancy. Recent studies show Propranolol efficacy on hemangioma treatment due to its rapid effect and a few side effects. The aim of this study was to assessment the efficacy of Propranolol on pediatric haemangioma.Methods: This quasi-experimental study was done on 20 children refer to Bu-Ali hospital. Treatment indications were multiple hemangioma, organ malfunction and enlarging hemangioma. Treatment of patients was started with 1 mg/kg/day and then increased to 3 mg/kg/day and continued for 6 month. Collected data analyzed by statistical methods in SPSS-19.Results: Patients mean age was 23.2 ± 11.2 months. 65% of them were female and 35% were male. The mean size of damages was 4.9 ± 3.3 cm. 70% of patients had acceptable response with more than 50% and 30% had partial response with less than 50% decrease in size. This effect is similar to corton effect (about 84%) but with less side effects.Conclusions: This study showed that Propranolol has acceptable effect on decreasing size of hemangioma and could be recommended as a first choice of hemangioma treatment.
Infantile hemangioma
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Clinical efficacy
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The combination of propranolol and pulsed dye laser for the treatment of infantile hemangiomas may be superior to either alone. This case report illustrates the additive effect of propranolol and pulsed dye laser for an infantile hemangioma in a high-risk location. Although thorough clinical trials are needed, combination therapy for infantile hemangiomas may prove to be optimal for efficacy.
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The treatment of parotid hemangiomas has posed a challenge. A male infant presented with large hemangioma of the right parotid gland diagnosed at the age of 3 months. Starting at the age of 4 months, he was treated with oral propranolol for 10 months, which led to a marked reduction in tumor size and strawberry hemangioma. Our case shows that propranolol is effective and safe in treating large parotid infantile hemangioma.
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To observe the efficacy and safety of oral propranolol in the treatment of periorbital proliferating phase infantile hemangioma.A retrospective review of patient medical records was performed. 12 patients (9 female, 3 male; 1.5-8.5 months, average 3.3 months) with periorbital proliferating phase infantile hemangioma underwent oral propranolol therapy. The dosage was slowly increased to 2 mg/kg daily in divided doses for a mean duration of 16 weeks (range 4 weeks-41 weeks). Therapeutic outcomes and safety were established by evaluating colour, size of lesion, duration of treatment and side-effects of treatment before and after treatment.Of these, 9 had a signification reduction in colour and size of the lesions, 2 had no further growth. 1 is stopped therapy due to hypotension after drug administration. 11 other patients, although mild adverse effects were noted, no symptoms were severe enough to discontinue treatment.Propranolol appears to be a safe and effective treatment in the management of periorbital proliferating phase infantile hemangioma.
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Infantile hemangioma is the most common vascular tumor in early childhood. Propranolol has been successfully used recently in a limited number of children with Infantile hemangioma. We present 6 cases of Infantile hemangioma, at a single dermatological center, which responded to oral propranolol with good results.
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The discovery of propranolol for the treatment of infantile hemangioma in 2008 has revolutionized management of this condition. Hundreds of reports have corroborated the initial published findings that propranolol is a safe and efficacious therapeutic agent. Furthermore, it is well tolerated in infants and can markedly alter the natural history and potential disfigurement of these lesions. The goal of this review is to outline the salient features of infantile hemangioma and the optimal use of propranolol as a first-line treatment modality.
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Infantile hemangioma
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Hemangioma is the most common benign cutaneous vascular tumor in infants and children. The Hemangioma incidence in the neonates is 2% to 3% that increases to 10% in those younger than one year of age. Before introduction of propranolol in 2008, different medications such as systemic corticosteroids and vincristine, with different side effects, were used for years. Since then, over 200 studies concerning propranolol administration have been published. This study reviews propranolol use in infantile hemangioma.
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Hemangiomas are indolent birthmarks of vascular origin, which are known to appear soon after birth, proliferate for 8-18 months, and then slowly regress over the next 5-8 years, leaving behind normal or slightly blemished skin. In rare instances, hemangiomas may encroach upon and endanger vital structures with a mortality of up to 60%. Multiple therapeutic modalities are available for hemangiomas with variable results and associated with side effects. We report two cases of hemangioma, successfully treated with propranolol. Case 1 was a 5-month-old female child who presented with a giant segmental hemangioma since birth. She was unable to open her left eye over the past 7 days. Within 48 hours of administering full dose of oral propranolol (2 mg/kg/day), the lesion decreased considerably, and the patient was able to open her eye. Case 2 was a 1-year-old female child who presented with hemangioma over the danger area of face. Oral propranolol was given for a period of 6 months with monthly follow up. Both the cases showed dramatic response, with more than 80% regression, without any relapse after stopping the treatment.
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For infantile hemangiomas (IH) requiring treatment, including those in high-risk locations or in the setting of ulceration, oral propranolol is first-line therapy. Here, we present three cases of infantile hemangioma with worsening ulceration following initiation or escalation of oral propranolol at standard doses.
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