Tertiary Hospital Experience in Outpatient Treatment of Infantile Hemangiomas: A Prospective Study

Background: Infantile hemangioma (IH) is observed at varying frequencies among children, impacting 10% of infants. The majority of uncomplicated IH cases experience spontaneous involution, while a minority necessitate intervention. This study aimed to assess the safety and effectiveness of propranolol in treating IH in Libyan pediatric patients. Methods: From 2013 to 2016, a total of 100 patients diagnosed with infantile hemangioma (IH) were monitored at a pediatric tertiary hospital's hematology clinic. Their demographic and clinical information, along with digital images of the lesions, were collected prospectively to evaluate coloration, size, and improvement of the hemangioma lesions. Following parental consent to initiate treatment, a regimen of oral propranolol, atenolol, or a combination of propranolol and steroids was commenced. Results: The study included 100 children diagnosed with infantile hemangioma (IH), consisting of 62% females and 38% males. Out of these, 68 children were treated exclusively with propranolol, while 12 were started on atenolol. The remaining 20 children received a combination of steroids and propranolol. Hemangioma lesions were primarily located on the face (56%). After an average follow-up duration of 10.53 ±7.21 months, among the 68 children treated solely with propranolol, 12 under the age of 12 achieved complete resolution of their hemangiomas, 15 demonstrated near-complete resolution, and the remaining 41 showed a significant reduction in hemangioma size without considerable disfigurement. Following a six-month discontinuation of propranolol, 2 children from this group experienced a relapse of their lesions. In one instance, the lesion resolved after 12 months of resuming propranolol, while the other required 18 months of treatment. Among the children treated with atenolol, two attained complete resolution, two had near-complete resolution, and 8 exhibited a significant reduction in hemangioma size. No relapses or changes in lesion size were noted after the cessation of atenolol. Conclusion: Oral propranolol is considered both safe and effective for the treatment of IH at a daily dosage of 2 mg/kg, with no significant adverse effects reported. Atenolol serves as an alternative to propranolol, while steroids, despite their potential side effects, have been shown to improve lesions in certain pediatric patients. Nevertheless, further large multicenter studies are necessary.