Treatment of infantile hemangiomas before and after the introduction of propranolol: A retrospective study

Background: Propranolol was introduced as systemic pharmacotherapy for problematic hemangiomas in 2008 and is now considered superior to corticosteroid. Other available treatment modalities include surgery and laser therapy. In November 2008, the first patient was treated with propranolol at The Center for Vascular Anomalies, Aarhus University Hospital. The aim of this study was to compare the treatment modalities applied before and after the actual date. Methods: The present study was a retrospective study of patients treated for hemangioma between 1995 and 2012 at the University Hospital of Aarhus, Denmark. Outcome measures of interest included age at referral, the extent of evaluation by different specialties, and the treatments administered. Results: One hundred twenty-one patients were included in the study. The patients were divided into two groups, patients treated before (study period 1) and after (study period 2) November 2008, respectively. In study period 2, patients were referred earlier for evaluation (0.82 versus 1.91 years, p=0.011). Fewer patients were seen by plastic surgeons in study period 2 (63.9 versus 98.8 %, p<0.001), with more patients being referred for systemic treatment (12.9 versus 86.1 %, p<0.001). No difference in the number of patients evaluated by dermatologists was detected (p=0.417). In study period 2, fewer patients were treated with surgery (38.9 versus 92.2, p<0.001) and laser therapy (13.9 versus 42.4, p=0.003). After November 2008, more patients have been treated with systemic pharmacotherapy (4.7 versus 80.6 %, p<0.001). Conclusion: The introduction of propranolol has resulted in a decline in surgery and laser therapy at our institution. More patients are being referred for systemic pharmacotherapy due to the treatment protocol of propranolol. Level of Evidence: Level IV, therapeutic study. © 2013 Springer-Verlag.