Clinical Outcomes of Nasal Tip Infantile Hemangiomas: A Retrospective Cohort Study

BACKGROUND: Infantile hemangiomas (IH) are the most common vascular tumors in infancy. Nasal tip infantile hemangiomas (NTIH) are associated with high-risk disfigurement and long-term sequelae. Despite widespread use of propranolol, optimal management of NTIH remains incompletely defined. METHODS: A retrospective cohort study included patients with NTIH evaluated between 2003 and 2019 at a pediatric referral center. Inclusion required confirmed diagnosis by two pediatric dermatologists, available clinical photographs, and ≥ 6 months of follow-up. Data collected included demographics, IH subtype, treatments, adverse events, and sequelae at 3 years old. Propranolol-treated patients were stratified by dose (≤ 2.5 vs. > 2.5 mg/kg/day). RESULTS: Fifty-eight patients met inclusion criteria. Propranolol was prescribed in 72.4% (n = 42), with a mean duration of 16.0 months. Adverse effects were predominantly mild (sleep disturbances, 20.7%). At 3 years of age, sequelae, particularly fibroadipose tissue, were significantly less frequent in propranolol-treated patients compared to those untreated (42.9% vs. 91.8%, p = 0.005; overall sequelae: 67.9% vs. 100%, p = 0.037). Sequelae rates did not differ between low- and high-dose propranolol groups. Combined propranolol and topical timolol was associated with increased telangiectatic sequelae, likely reflecting treatment selection bias. No association was found between IH subtype and sequelae. CONCLUSION: Systemic propranolol was associated with fewer long-term sequelae in NTIH, particularly fibroadipose tissue. A lower dose of 2 mg/kg/day appears sufficient in most cases. Topical timolol may provide limited additional benefit and should not delay propranolol initiation. These findings support early systemic propranolol as the standard of care in NTIH management.