Propranolol and PDL clear infantile hemangiomas

Kissimmee, Fla. - The use of propranolol and pulsed dye laser (PDL) led to more rapid clearing of infantile hemangiomas than propranolol alone, according to a retrospective chart review presented at the 2012 annual meeting of the American Society for Laser Medicine and Surgery.

Physicians reviewed charts from infants who had been treated with both propranolol and PDL, either concurrently or sequentially, and compared outcomes with infants who were treated with propranolol alone.

The overall resolution of the hemangioma was rated by blinded physician assessment of patient photographs. Length of treatment until complete or near-complete resolution had been reached was recorded, as was the length of propranolol treatment to reach near or complete resolution, and the number of PDL treatments to reach near-complete or complete resolution.

"We judged effectiveness by the level of clearance of the hemangioma," says Kavitha Reddy, M.D., a fellow at the Laser & Skin Surgery Center of New York, who presented the data.

There was complete or near-complete clearance in all nine patients who received concurrent, combination therapy, compared with only two of the five patients who received propranolol monotherapy (three being left with residual, superficial disease). Seven patients each had residual, superficial hemangioma after propranolol therapy and were referred for PDL; all achieved near complete or compete clearance after PDL treatments.

Subjects who received concurrent combination therapy reached complete or near-complete clearance after a mean 81 days of propranolol treatment, compared with 225 days for propranolol alone. In those patients who received sequential propranolol-PDL therapy, it took a mean 160 days to achieve complete or near complete clearance.

Roy Geronemus, M.D., director at the Laser & Skin Surgery Center of New York and the study's principal investigator, notes that combination therapy, particularly when given concurrently, results in faster clearance and allows for a shorter course or reduced total dosage of propranolol therapy.

"We were able to shorten the duration of propranolol treatment," Dr. Geronemus says. "It (propranolol) is not a benign drug, and it requires monitoring."

Disclosures: Dr. Geronemus is on the medical advisory board for Candela. Dr. Reddy reports no relevant financial interests.

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