50 Years Ago in The Journal of Pediatrics: Successful Treatment of Juvenile Hemangiomas with Prednisone

Abstract

Fost NC, Esterly NB. J Pediatr 1968;72:351-7. Infantile hemangioma, the most common infantile soft tissue tumor, has a prevalence of 4%-5%, and although uncomplicated infantile hemangioma can be followed clinically while awaiting involution, up to 15% may be associated with functional impairment, tissue destruction, or permanent disfigurement which necessitates therapy. In 1968, Fost and Esterly reported in The Journal 6 patients with severe infantile hemangioma who were treated with prednisone, with regression noted in 5. Their patients had complications including ulceration, external auditory canal compression, periorbital involvement/proptosis, and subglottic involvement necessitating tracheostomy. Oral prednisone was administered at 20-30 mg daily for 2-16 weeks, and the authors noted marked improvement in 5 patients, with mild growth retardation in one as the only complication. Following up on preliminary observations by Zarem and Edgerton,1Zarem H.A. Edgerton M.T. Induced resolution of cavernous hemangiomas following prednisolone therapy.Plast Reconstr Surg. 1967; 39: 76-83Crossref PubMed Scopus (250) Google Scholar Fost and Esterly's findings helped foster the adoption of corticosteroids as first-line treatment for infantile hemangioma. They remained the mainstay of therapy for 4 decades, until the serendipitous discovery in 2008 of propranolol's effects against infantile hemangioma altered this paradigm. Leaute-Labreze et al2Leaute-Labreze C. de la Roque E.D. Hubiche T. Boralevi F. Thambo J.B. Taieb A. Propranolol for severe hemangiomas of infancy.N Engl J Med. 2008; 358: 2649-2651Crossref PubMed Scopus (1811) Google Scholar reported 2 infants with massive infantile hemangioma treated with propranolol (for cardiac indications) with marked improvement, and 9 others with severe infantile hemangioma who were subsequently treated prospectively. A randomized trial of propranolol confirmed its efficacy in infantile hemangioma therapy,3Leaute-Labreze C. Hoeger P. Mazereeuw-Hautier J. Guibaud L. Baselga E. Posiunas G. et al.A randomized, controlled trial of oral propranolol in infantile hemangioma.N Engl J Med. 2015; 372: 735-746Crossref PubMed Scopus (478) Google Scholar and in 2014, the US Food and Drug Administration approved oral propranolol hydrochloride solution for this indication. Propranolol is now considered first-line therapy for complicated infantile hemangioma. This small case series substantiated a relatively well-tolerated and effective treatment for complicated infantile hemangioma and was a significant contribution to the period literature. Their report, and the recent discovery and validation of propranolol's effects against infantile hemangioma, remind us of the potential benefits to our patients of academic curiosity, scientific validation, and scholarly dissemination. Dr Nancy Esterly passed away on October 8, 2017. She was a giant in the field, often referred to as the “mother of pediatric dermatology”, and helped establish our journal, Pediatric Dermatology. The epitome of an academic scholar, savvy clinician, and extraordinary mentor, Dr Esterly's legacy continues to inspire, and will do so for generations to come.