The Efficacy and Safety of Atenolol for Treatment of Infantile Hemangioma

ABSTRACT Background Infantile hemangiomas are the most common benign vascular tumours in children. Since the discovery of propranolol for infantile hemangiomas, its increasing side effect profile has prompted research into its beta‐1‐selective counterpart, atenolol. Studies have shown that atenolol is equally effective and more tolerable than propranolol. However, there remains a lack of consensus surrounding atenolol standard dosing and escalation guidelines. Objectives To retrospectively assess the efficacy and side effects of atenolol used for children with infantile hemangiomas requiring oral beta‐blocker therapy. Methods A retrospective cohort study at a tertiary dermatology clinic from January 2022 to September 2023 identified infants treated with atenolol for infantile hemangiomas. Infant demographic, lesion characteristics and treatment outcomes were analysed and compared between those who received 1, 1.5 or 2 mg/kg/day of oral atenolol. Results Of 83 eligible patients, 14.4% ( n = 12) remained on 1 mg/kg/day, 42.2% ( n = 35) received 1.5 mg/kg/day, and 43.4% ( n = 36) increased to 2 mg/kg/day. Overall, 98.8% ( n = 82) responded to atenolol, with 88% ( n = 73) exhibiting a substantial response. Complete involution was associated with earlier age of atenolol commencement ( p = 0.009). Lesions that required escalation to 2 mg/kg/day were more commonly associated with anatomical disfigurement ( p = 0.0121), or were deep, mixed, periorbital, lip or nose infantile hemangiomas. Lesions causing functional impairment were associated with a longer duration of treatment ( p < 0.001). Adverse effects requiring treatment cessation occurred in 3.6% ( n = 3), all being behavioural changes. Conclusions Atenolol has proven to be an efficacious, safe and tolerable medication for infantile hemangiomas and is a suitable alternative to propanolol. Almost all infants responded to atenolol therapy with more than 50% responding adequately to 1.5 mg/kg/day or less. Infants may be safely commenced on these lower doses with grading up according to response, rather than routinely escalating to 2 mg/kg/day.