Prevention and treatment of hemangioma rebound after discontinuation of propranolol.

Abstract

Propranolol is the drug of first choice in the treatment of problematic hemangioma. How-ever, it remains to deal with the problem of its recurrence after drug discontinuation. The recurrence, usually negligible, is significant in about one fifth of the cases. We then made a retrospective study of cases treated up to 2009 and a prospective study for the cases treated from 2010 onwards, aimed at identifying the factors responsible for the rebound and trying to avoid it. 99 children who had started the treatment within 2012 and had discontinued it from at least six months, 69 females and 30 males, ranging in age between 1 and 19 months at the beginning of the treatment, with a median age of 4.3 months entered the study. The regression of hemangioma was complete in 49 children (RE group), while in 21 children there was a rebound more than 20% (RI20 group). We compared the clinical data and treatment modalities in the two groups. Risk factors for a significant rebound in the hemangioma after discontinuation of propranolol were female sex, duration of treatment with propranolol less than 10 months, localization to the cheek and less than 30% improvement after the first month of treatment. To prevent the rebound we propose to increase the initial 2 mg/kg per day dosage of the drug up to 3 mg in cases with less than 30% improvement after the first month of therapy and increase the duration of treatment with propranolol especially in females and in hemangioma of the cheek. To treat the rebound we propose a 4-month second cycle of propranolol, possibly associated in the case of ocular and subglottic hemangioma with deflazacort 1 mg/kg/ day in the first month, tapered and then suspended in the next two months.