Diagnosis and Management of Infantile Hemangioma

Table 12. Resolution outcomes in studies comparing intralesional propranolol and triamcinolone
Rebound
Resolution Growth/
Age, Months
Outcomes Recurrence
Author, Year
Comparison Groups
(n)
Quality
Awadein et al. 2011 130
G1: Propranolol,
intralesional 1mg/ml
(12)
G2: Triamcinolone,
intralesional
40mg/ml(10)
Quality: Poor
Type
Age,
mean±SD
G1: 5.9±2.7
G2: 6.1±2.9
Type
NR
Location
G1+G2:
Periocular
Methods and
Measures of
Resolution/
Response
• Size measured
by clinical
examination
and
photography
• Response
graded as:
Excellentcomplete
resolution
achieved
Goodsustained
plateau with ≥
50% reduction
Fair-sustained
plateau with <
50% reduction
Poor-no
response or
worsening
• Blinded
assessment:
NR
Regression of IH
G1:10/12 (83%)
G2: 8/10 (80%)
Response
Excellent
response
G1:5/12 (42%)
G2: 4/10 (40%)
Good
G1:3/12 (25%)
G2: 2/10 (20%)
Fair
G1:2/12 (17%)
G2: 2/10 (20%)
Poor
G1:2/12 (17%)
G2: 2/10 (20%)
Other
Outcomes
Rebound
growth, n
G1:4
G2: 3
Abbreviations: G = group; IH = infantile hemangioma; mg = milligram; ml = milliliter; n= number; NR = not reported;
SD = standard deviation
Vision
outcomes
• Significant
reduction in
astigmatic
error in both
the
propranolol
group
(p=0.02) and
the steroid
group
(p=0.03) but
there was no
between
group
differences
(p=0.34,
n=22)
• No
significant
group
difference in
the degree
of ptosis
(p=0.46)
Propranolol Plus Pulsed Dye Laser Versus Propranolol Alone
A fair quality retrospective cohort study compared three treatments for facial segmental IH:
concurrent propranolol and pulsed dye laser (n=12), propranolol followed by pulsed dye laser
(n=5), and propranolol alone (n=8) (Table 13). 150 Mean hemangioma size was larger in the
concurrent treatment group (41.65 cm 2 ) than the sequential (20.1 cm 2 ) and propranolol-only
groups (18.0 cm 2 ). Among the 12 participants who received concurrent propranolol and pulsed
dye laser, six (50%) had complete clearance and six (50%) had near-complete clearance. All five
of the participants in the propranolol followed by pulsed dye laser group also had complete (n=2,
40%) or near-complete (n=3, 60%) clearance. Among the eight participants who receive
propranolol alone, one (13%) had complete clearance, two (25%) near-complete clearance, and
five (63%) partial clearance. The difference in effectiveness between combined therapy, either
concurrently or sequentially, and propranolol alone was statistically significant. The number of
days of propranolol treatment until near-complete clearance was significantly lower (p