Treatment Of Infantile Hemangiomas Research Articles

Propranolol: A Promising Therapeutic Avenue for Classic Kaposi Sarcoma

Introduction: Kaposi sarcoma (KS) is a low grade angio-proliferative tumor of endothelial origin. Human herpes virus 8 (HHV8) plays a major role in the pathogenesis of KS. Classic Kaposi sarcoma is commonly seen among elderly of Mediterranean origin. It is usually slowly progressive and is rarely fatal. There is no definitive cure for KS. Beta blockers were used with great success in the treatment of infantile hemangioma. Because of some similarity between infantile hemangioma and Kaposi sarcoma, topical beta blockers were tried with variable success rate. Objectives: We aimed to assess the efficacy and safety of oral propranolol in the treatment of classic Kaposi sarcoma. Methods: Fifteen patients diagnosed with classic Kaposi sarcoma were prospectively enrolled in the study. Detailed history and full clinical examination were conducted. Histopathological diagnosis with confirmatory immune staining was done for all patients. Oral propranolol in a dose of 60 mg was given per day for 6 months. The patients assessed clinically as complete responders, partial responders, and non-responders. Results: Nine patients (60%) were partial responders; showed 50% reduction in the number of the existing lesions, and 6 patients (40%) were considered non-responders; 3 with stable disease and 3 with progressive disease. Lymphedema partially improved in 1 patient. Conclusions: Oral propranolol is a safe and good option for treatment of patients with non-complicated classic Kaposi sarcoma, especially elderly with multiple comorbidities.

The timing and safety of topical timolol treatment for superficial infantile hemangioma: a retrospective cohort study

Numerous studies have shown that topical timolol is effective in treating infantile hemangioma (IH) with minimal adverse events. However, consensus is lacking on optimal timing, dosage, frequency, and safety parameters for this treatment. This study aims to explore the timing and safety of topical timolol treatment for superficial IH. A retrospective analysis included pediatric IH patients who underwent topical timolol treatment at the Department of Pediatric Surgery of Sichuan Provincial People’s Hospital between January 2019 and January 2023. Medical records were reviewed for patient information, lesion characteristics, outcomes, and complications. Topical timolol was administered to 666 IH patients. Median follow-up was 10 months. 480 cases had excellent or good outcomes, while 186 had fair or poor outcomes. Patients ≤ 3 months had better outcomes than those > 3 months (Z = 4.713, P < 0.001). Small IH had better outcomes than large IH (Z = 1.991, P = 0.046). Lesion locations did not significantly affect outcomes (H = 10.252, P = 0.114). Respiratory problems occurred in 58 (8.7%) cases, localized skin irritation occurred in 48 (7.2%) cases, sleep disturbance occurred in 30 (4.5%) cases, and residual skin lesions occurred in 26 (3.9%) cases. In 59 (8.8%) cases the IH had relapses.Conclusions: Topical timolol is safe and effective for IH. Patients who are aged 1 < months ≤ 3 or have small (1.5 cm < max diameter ≤ 5 cm) IH are more likely to experience better outcomes. It also may reduce the incidence of residual skin lesions and relapse. Therefore it may be a useful alternative therapy option for superficial IH.What is Known:• β-blockers are now considered to be first-line treatment of infantile hemangioma.• Topical timolol treatment is safe and effective for infantile hemangioma.What is New:• Patients who are aged ≤ 3 months or have a max diameter ≤ 5 cm infantile hemangioma are likely to experience better outcomes by topical timolol treatment.• Topical timolol treatment may reduce the incidence of residual skin lesions and infantile hemangioma relapses.

DEVELOPMENT AND VALIDATION OF SPECTROPHOTOMETRIC DETERMINATION OF PROPRANOLOL IN EXTEMPORANEOUS POWDERS OF MANUFACTURE FOR CHILDREN

Introduction. Propranolol, a non-selective beta-blocker, is included in Russian and international treatment protocols for various cardiovascular diseas-es in children and adults. It has also demonstrated efficacy in the treatment of infantile hemangiomas, migraines, glaucoma and other diseases. The pharmaceutical industry produces propranolol in tablets of 10 and 40 mg. However, for pediatric treatment, dosages of 0.5–2.5 mg/kg/day are re-quired. Extemporaneous pharmaceutical powders for internal use allow for individual dosing. This study aims were to develop method for the quantitative determination of propranolol by spectrophotometric method in powders containing dex-trose or lactose and to carry out validation assessment of this method. Material and methods. The pharmaceutical substances propranolol hydrochloride was purchased from (Changzhou Yabang Pharmaceutical Co., Ltd, China), dextrose monohydrate – from (Weifang Shengtai Medicine Co., Ltd, China) and lactose monohydrate – from (DFE Pharma GmbH&amp;Co. KG, Goch, Germany). The optical density of propranolol solutions was measured on a UNICO 2802 spectrophotometer (Russia) at a wavelength of 290 nm in cu-vettes with a layer thickness of 10 mm. Weighing of the samples was carried out on an analytical balance ADV-200M (Russia). Results. The method has been developed for the spectrophotometric quantitative determination of propranolol in powders containing dextrose or lac-tose. The validation of the method was carried out by the requirements of OFS.1.1.0012 “Validation of analytical methods” of the Russian State Phar-macopoeia of the XV edition, confirmed its specificity, linearity in the range from 12 to 28 µg/mL (r=0,9995 for dextrose powder и r=0,9997 for lactose powder), intermediate (intra-laboratory) precision and accuracy. The results are not burdened by systematic error. The relative standard deviation (RSD) does not exceed 2.0%. Conclusions. A validation evaluation of a spectrophotometric method for the quantitative determination of propranolol in powders with dextrose or lac-tose has been developed and carried out. The proposed method can be used to control the quality of extemporal medicines.

Oral Propranolol in the Treatment of Cutaneous Infantile Hemangioma in Children: A 3-Years Retrospective Study

Background: Infantile hemangioma is the most common vascular tumor in children. The primary pharmacological agent currently utilized for its treatment is propranolol, which demonstrates efficacy and minimal and non-severe side effects. Objective: To investigate the therapeutic outcomes and adverse effects of orally administered propranolol in the treatment of infantile hemangioma. Additionally, to explore patient data regarding disease manifestations and progression. Material and Methods: Retrospective data collection from medical records of patients diagnosed with cutaneous infantile hemangioma and treated at the National Children’s Health Institute for a duration of three years, between January 1, 2018 and December 31, 2020, was done. Results: The present study included 180 patients with infantile hemangioma. The male-to-female ratio was 1 to 2.3. The median age at diagnosis and treatment initiation was four months, ranging from 1 week to 18 months. Premature infants accounted for 28 cases (15.6%). The most common locations were the head, face, and neck with 67.8%, trunk with 16.1%, and limbs with 16.1%. The most prevalent complications were ulcerations for 12.2% and visual field defects for 0.6%. The average duration of propranolol treatment was 13.01 months. Favorable response was noted in 173 patients (96%) at the 2-week follow-up. By the 6-month follow-up, all patients exhibited positive treatment responses. Adverse effects were reported in two cases, including hypoglycemic seizure and irritability. Conclusion: Oral propranolol demonstrates favorable outcomes in treating infantile hemangioma. However, vigilant monitoring for severe adverse effects, particularly hypoglycemia-induced seizures must be done. Guardians must be informed and deeply concerned not to administer propranolol on an empty stomach, in the presence of poor feeding, or in poor physical condition. Keywords: Oral propranolol; Infantile hemangioma; Adverse events; Hypoglycemia

Efficacy and safety of oral propranolol and topical timolol in the treatment of infantile hemangioma: a meta-analysis and systematic review.

Propranolol, a nonselective β-blocker, is the first-line treatment for infantile hemangioma (IH). Topical timolol has recently been proposed as a novel IH treatment with fewer adverse effects. This study was conducted to compare the efficacy and safety of oral propranolol and topical timolol for treating IH. Studies were included after searching PubMed, Embase, Web of Science, and the Cochrane Library via the keywords of "propranolol", "timolol", "infantile hemangioma" and their synonyms. A meta-analysis with pooled odds ratios was performed using the fixed-effect model. Seven articles with 2071 patients were included in this meta-analysis. Compared with topical timolol, oral propranolol had a greater response rate (OR = 2.12, P < 0.001), but it was also associated with a greater risk of adverse events (OR = 2.31, P < 0.001). For superficial IH, timolol demonstrated similar efficacy to propranolol (OR = 1.28, P = 0.34) but with fewer adverse events (OR = 2.30, P = 0.001). Additionally, compared with topical timolol, propranolol at a dosage of 2mg/kg/d had a better response rate (OR = 2.62, P < 0.001), whereas the 1.0∼1.5mg/kg/d propranolol group showed no significant difference (OR = 1.34, P = 0.38). Oral propranolol presents superior therapeutic efficacy in the treatment of IH compared to topical timolol. However, topical timolol can serve as an alternative to oral propranolol for treating superficial IH, providing similar efficacy with fewer adverse effects. Additionally, propranolol at a dosage of 2mg/kg/d offers greater efficacy with a comparable safety profile, whereas the 1.0∼1.5mg/kg/d propranolol dosage shows no significant difference in efficacy compared to timolol but is associated with more adverse events. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024603724, identifier CRD42024603724.

Diagnosis and Treatment of Infantile Hemangioma from the Primary Care Paediatricians to the Specialist: A Narrative Review.

Infantile haemangiomas (IHs) affect 3-10% of infants, 10% of whom need topical or systemic beta-blocker therapy. Propranolol is the first choice for IHs with a high risk of complications. Since more than half of IHs leave a permanent mark, to reduce outcomes, it is essential to start oral propranolol (2-3 mg/kg/day in 2 doses/day) within the 5th month of life (i.e., during the proliferative phase) and to complete the therapy cycle for at least 6 months. This review aims to summarise the epidemiology, clinical presentation, diagnosis, and treatment of IHs and to highlight the importance of proper referral to specialised hub centres. Patients with vascular anomalies, particularly those suspected of having IH, should be referred to a specialised centre for accurate diagnosis, management by a multidisciplinary team, and timely treatment. IHs may pose life-threatening, functional, and aesthetic risks or may ulcerate. Segmental infantile haemangioma of the face/neck and the lumbosacral regions can be associated with various malformations. To ensure timely specialist evaluation and treatment to reduce the potential risk of complications, it is essential to identify high-risk IHs rapidly. The Infantile Haemangioma Referral Score (IHReS) scale is an important tool to assist primary care paediatricians and general dermatologists.

JAAD Game Changers: “Propranolol treatment of infantile hemangioma (IH) is not associated with developmental risk or growth impairment at age 4 years”

JAAD Game Changers: “Propranolol treatment of infantile hemangioma (IH) is not associated with developmental risk or growth impairment at age 4 years”

Use of modified human hemangioma tissue cultures and human umbilical vein endothelial cell cultures to gain mechanistic insights into imiquimod treatment for infantile hemangioma.

Infantile hemangiomas (IH) are a common entity encountered by dermatologists, otolaryngologists, and other surgeons. Oral propranolol is a mainstay of treatment for IH and is well-tolerated, though propranolol-refractory IH and other drug-related adverse events are documented and can limit its usage. There are few in vitro testing systems for putative treatment agents. To address this, we modified a tissue culture system for human hemangioma treatment testing to evaluate the treatment impact of the immune modifier, imiquimod. Human umbilical vein endothelial cells (HUVEC) and hemangioma cultures were treated with several concentrations of imiquimod followed by MTT assays, reporter gene assays, PCR, ELISA, and Western blotting for IL-8, VEGF, Cyclin D1, and IFNα and immunohistochemistry for Cyclin D1 and Ki-67. HUVEC showed acute decreases in IL-8, VEGF, and Cyclin D1 promoter activity and increases in IFNα mRNA after imiquimod treatment. Hemangioma samples showed no change in Ki-67 or Cyclin D1 staining after treatment with imiquimod after 27 d, with significantly increased IL-8 and VEGF. From this preliminary analysis, we discerned that hemangioma tissues can be grown in tissue culture and used for drug treatment studies. We also conclude acute and chronic modulation of cell cycle, angiogenesis factors, and immunostimulatory conditions may be associated with imiquimod mechanisms of action in hemangioma involution.

Safety of Prior Propranolol Therapy for Infantile Hemangioma.

Propranolol has been the primary treatment for infantile hemangioma (IH) since 2008. Prior studies have investigated the effects in late childhood of propranolol therapy given in infancy for IH, including neurocognitive dysfunction, sleep disorders, and hypoglycemia. However, few studies have determined the risk of these adverse effects later in life. Using the TrinetX database, we studied the risk of growth impairment, sleep disorders, learning disabilities, and diabetes mellitus in children aged 10-17 years who had received propranolol for IH in infancy. The maximum age of 17 years was chosen for the study, as propranolol was established as a treatment for IH in 2008. The results showed no statistically significant risk of growth impairment, sleep disorders, learning disabilities, or diabetes mellitus in IH patients treated with propranolol. These findings support existing evidence that propranolol therapy given in infancy for IH is not associated with long-term adverse effects up to age 17 years in the studied patient population.

Efficacy and safety of atenolol versus propranolol for treatment of infantile haemangioma: A narrative review.

Infantile haemangiomas (IH) remain the most common benign vascular tumours in childhood. While most IH can be managed conservatively, a proportion of these lesions can cause disfigurement, ulceration or functional impairment, requiring prompt intervention. Propranolol, a lipophilic non-selective beta blocker, has been regarded as first-line therapy, following a serendipitous discovery of its use for IH in 2008. While efficacious, it has been associated with adverse effects such as hypoglycaemia, bronchospasm, sleep disturbances and agitation in infant trials. Hence, atenolol, a hydrophilic beta-1 selective blocker, has demonstrated similar efficacy and potentially greater tolerability, being less likely to cause sleep disturbances given its inability to cross the blood brain barrier, and a decrease in bronchial reactivity. The purpose of this review is to explore and critique the current knowledge on the efficacy and safety of propranolol against atenolol in children with IH. A total of seven studies comparing the two beta-blockers were identified in our search. Atenolol appeared to be as efficacious as propranolol and was associated with fewer central nervous system and bronchial-related adverse events. Further research exploring the optimal dosing for atenolol, particularly for ulcerated or syndromic IH, as well as incidence and management of rebound growth would be beneficial.

Identifying Potential Diagnostic and Therapeutic Targets for Infantile Hemangioma Using WGCNA and Machine Learning Algorithms.

Infantile hemangioma (IH) is the most common benign vascular tumor during infancy and childhood and is characterized by abnormal vascular development. It is the most common vascular tumor and its related mechanisms and treatments remain a problem. IH-related biomarkers have been identified using transcriptome analysis and can be used to predict clinical outcomes. This study aimed to identify the key target genes for IH treatment and explore their possible roles in the IH pathophysiology. Gene records were acquired from the Gene Expression Omnibus database. Utilizing integrated weighted gene co-expression network examination, gene clusters were determined. Single-sample gene set enrichment analysis was performed to gauge immune infiltration. Essential genes were identified via Random Forest and Least Absolute Selection and Shrinkage Operator analyses. Ultimately, a set of five pivotal genes associated with the ailment was identified (NETO2, IDO1, KDR, MEG3, and TMSB15A). A nomogram for predicting IH diagnosis was constructed based on hub genes. The calibration curve showed valid agreement between the prediction and conclusion that the key genes in the model were clinically significant. Neuropilin and Tolloid-like 2 (NETO2) are closely associated with tumor development. The role value of NETO2 expression levels increased in hemangioma-derived endothelial cells (HemECs). After silencing NETO2, the growth and migration of cancer cells were significantly restrained. This study revealed the critical role of NETO2 in IH development, suggesting that targeting NETO2 may be effective in improving the therapeutic outcome of IH.

Solid Lipid Nanoparticles Based Topical Hydrogel for Potential Treatment of Infantile Hemangioma

Solid Lipid Nanoparticles Based Topical Hydrogel for Potential Treatment of Infantile Hemangioma

R(+) Propranolol decreases lipid accumulation in hemangioma-derived stem cells.

Infantile hemangioma (IH) is a benign vascular tumor that undergoes an initial rapid growth phase followed by spontaneous involution. A fibrofatty residuum remains in many tumors and often necessitates resection. We recently discovered that R(+) propranolol, the non-β blocker enantiomer, inhibits blood vessel formation of IH patient-derived hemangioma stem cells (HemSC) xenografted in mice. HemSC are multipotent cells with the ability to differentiate into endothelial cells, pericytes, and adipocytes. We investigated how R(+) propranolol affects HemSC adipogenic differentiation and lipid accumulation, in vitro and in a preclinical murine model for IH. We conducted a 10-day adipogenesis assay on 4 IH patient-derived HemSCs. Oil Red O (ORO) staining was used to identify the onset and level of lipid accumulation in HemSC while quantitative real-time polymerase chain reaction was conducted to determine the temporal expression of key factors implicated in adipogenesis. 5-20µM R(+) propranolol treatment was added to HemSC induced to undergo adiogenesis for 4 and 8 days, followed by quantification of lipid-stained areas and transcript levels of key adipogenic factors. We immunostained for lipid droplet-associated protein Perilipin 1 (PLIN1) in HemSC-xenograft sections from mice treated with R(+) propranolol and quantified the area using ImageJ. We found that different patient-derived HemSC exhibit a robust and heterogenous adipogenic capacity when induced for adipogenic differentiation in vitro. Consistently across four IH patient-derived HemSC isolates, R(+) propranolol reduced ORO-stained areas and lipoprotein lipase (LPL) transcript levels in HemSC after 4 and 8 days of adipogenic induction. In contrast, R(+) propranolol had no significant inhibitory effect on transcript levels encoding adipogenic transcription factors. In a pre-clinical HemSC xenograft model, PLIN1-positive area was significantly reduced in xenograft sections from mice treated with R(+) propranolol, signifying reduced lipid accumulation. Our findings suggest a novel regulatory role for the R(+) enantiomer of propranolol in modulating lipid accumulation in HemSC. This highlights a novel role of R(+) propranolol in the involuting phase of IH and a strategy to reduce fibrofatty residua in IH. Propranolol is the mainstay treatment for infantile hemangioma (IH), the most common tumor of infancy, but its use can be associated with concerning β-blocker side effects.R(+) propranolol, the enantiomer largely devoid of β-blocker activity, was recently shown to inhibit endothelial differentiation of hemangioma-derived stem cells (HemSC) in vitro and reduce blood vessel formation in a HemSC-derived xenograft murine model of IH. R(+) propranolol inhibits lipid accumulation in HemSC in vitro.R(+) propranolol does not affect mRNA transcript levels of key adipogenic transcription factors in differentiating HemSC in vitro.R(+) propranolol reduces lipid accumulation in a pre-clinical xenograft murine model of IH. The R(+) enantiomer of propranolol could be advantageous in terms of reduction in β-adrenergic side effects and fibrofatty tissue formation in the involuting phase of IH.Less fibrofatty residua might reduce the need for surgical resection.Disfigurement and associated psychosocial impacts might be improved in this young patient cohort.

Safety of propranolol in neonates with severe infantile hemangiomas: A fourteen-year experience

Background: Infantile hemangiomas (IH) are the most common vascular tumors of infancy. Nearly 4–10% of infants require systemic treatment due to uncontrolled endothelial cell proliferation. Oral propranolol has been approved for the treatment of IH. Herein, we present our experience about the safety and tolerance of this treatment. Materials and Methods: This was a fourteen-year, prospective study conducted between 2008 and 2022 by the dermatology and pediatrics departments of the Hassan II University Hospital Center, located in Fez, Morocco, involving 215 children with infantile hemangioma with an indication for treatment by oral propranolol. Results: After a median follow-up period of fourteen years, the mean age of onset was six months. We encountered a 19% rate of side effects. Therapy was interrupted due to the occurrence of bronchospasm in two cases. Four patients (2.5%) had episodes of bronchiolitis. Other side effects were digestive disorders in 3%, sleep disorders in 6 cases, and coldness of the extremities in 7 cases. Four patients (8.6%) had a volumetric rebound. However, we noted sequelae, such as residual telangiectasias (39% cases), anetodermal skin in 15%, and unsightly scars in 24%. Conclusion: Our data shows that propranolol was generally well tolerated by young infants. We found side effects to be mostly minor, transient, and manageable, except for two cases of bronchospasm, whose treatment was permanently discontinued. This may be explained by the late age of treatment onset, yet we noted sequelae, such as telangiectasias and anetodermal skin. Key words: Propranolol, Infantile hemangioma, Safety

A Systematic Review on Management of Infantile Hemangiomas: How Far We Have Reached in this Past Decade

Infantile hemangioma (IH) is a common condition in children. It may lead to cosmetic disfigurement, functional impairment, and various complications. There are various treatment options available for this condition. This article aims to discuss the various therapeutic options available for the treatment of IH. We searched PubMed, Google Scholar, and Embase (from December 2013 to December 2023) for human studies/case reports/case series assessing the management of IH. We reviewed 198 papers including different therapeutic regimens. β-blockers other than propranolol, such as nadolol, timolol, atenolol, acebutolol, and captopril, have shown comparable results to propranolol. Pulsed dye laser (PDL) and neodymium-doped yttrium aluminum garnet laser have shown promising results. Other therapies observed were sclerotherapy, cryotherapy, and surgical resection. A conventional combination of β-blockers with a laser might be the first-line treatment to arrest the growth of IH. PDL has shown promising results.

Beta-blockers for the treatment of infantile haemangiomas in premature infants.

Beta-blockers have been established as a treatment of infantile haemangiomas (IH) since its serendipitous discovery for use in IH in 2008. However, data on the safety of these beta-blockers for use in IH in preterm infants are scarce. A retrospective study was performed to review the safety of oral propranolol and topical timolol in the treatment of IH in a cohort of preterm infants treated at our tertiary paediatric hospital. It was observed that there was an increased risk of adverse events amongst the preterm infants with chronic lung disease, retinopathy of prematurity and gastroesophageal reflux, when treated with oral propranolol.

Comparative Outcomes of Propranolol Monotherapy and Combined Therapy with Intralesional Triamcinolone in Infantile Hemangioma

Background: Infantile Hemangiomas (IHs) are the most common vascular tumors of infancy. Oral propranolol has achieved great success in treating IHs since 2008. Recently combined oral propranolol with intralesional injection of Triamcinolone acetonide is the effective method of treatment for infantile Hemangioma with minimal adverse effects. Objectives: To observe the outcome of Propranolol monotherapy and combined therapy with intralesional Triamcinolone in Infantile Hemangioma. Materials and Methods: This prospective study was carried out in the Department of Pediatric Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, during the period from January 2018 to December 2019. It included 42 infantile hemangioma patients divided into two groups: Group A (21) treated with oral propranolol, and Group B (21) treated with oral propranolol plus intralesional triamcinolone acetonide. Patients were followed up at regular intervals for 6 months. Results: The data of two groups of patients with IH were compared in the study. The demographic variables, including median age, sex, size, type, and site of IH, were comparable between the two groups. This showed that pre-treatment complications were slightly higher in Group B but not significantly different. Superior size reduction was observed in Group B (71.4% vs. 38.1%), though the difference was not significant statistically. Group B had excellent color regression, which was significantly higher compared to the other group (90.5% vs. 9.5%, p &lt; 0.001). The mean treatment cost was higher in Group B, which was 187.86. taka compared to 124.76. taka in Group A (P value was &lt;0.001). In summary, Group B had better color regression of the pinprick but at a higher cost of treatment as compared to Group A, and other parameters were almost equal in both groups. Conclusion: Combined propranolol and intralesional Triamcinolone is more effective compared to propranolol alone in the treatment of IHs.

Cardiac Evaluation before and after Oral Propranolol Treatment for Infantile Hemangiomas.

Background: Most recent clinical practice guidelines addressing the management of infantile hemangiomas (IHs) recommend oral propranolol, a non-selective beta-adrenergic antagonist, as first-line treatment. However, few reports have provided continuous follow-up data regarding cardiac evaluations. Methods: Sixty-four patients diagnosed with IHs and treated with oral propranolol before 2 years of age at the Department of Pediatrics, Kangbuk Samsung Hospital (Seoul, Republic of Korea), with regular examinations between 2017 and 2021, were included. Cardiac evaluations, including electrocardiography, Holter monitoring, chest X-ray, and echocardiography, were performed. Results: Sixty-four patients with IHs successfully underwent continuous follow-up cardiac evaluations. The median age at diagnosis was 2 weeks (1 day to 34.3 weeks). The median age at treatment initiation was 13.6 weeks (2.4-87.9 weeks), the mean longitudinal diameter of hemangioma at diagnosis was 2.8 ± 2.1 cm (0.3-12.0 cm), and the mean percentage of size decrease after 1 year of oral propranolol treatment was 71.8%. None of the 64 patients experienced severe adverse side effects during propranolol treatment. There was no statistically significant differences in echocardiographic function and electrocardiographic data after treatment. Conclusions: Propranolol treatment ≥6 months was effective and safe without significant cardiac toxicity in the treatment of patients with infantile hemangiomas.

Cryocarboxy Surgery: A New Armamentarium in the Treatment of Infantile Hemangiomas of the Lips.

Cryotherapy was reported in the treatment of infantile hemangiomas by many studies using liquid nitrogen as a cryogen. To evaluate the outcome of cryo-carboxy surgery in treatment of infantile lip hemangiomas. In this study, we present the use of carbon dioxide as the cryogen in 50 patients with infantile hemangiomas of the lips with successful results. The patient evaluation was done including the improvement in color, texture, and volume of the lesion and each of the three parameters was given a score on a 4-point scale; excellent, good, fair, or poor. The average evaluation score of our patients was excellent in 37 (74%) cases and good in 13 (26%) cases. We had no fair or poor results. There was no postprocedural hypopigmentation in any of the patients with lesions limited to the mucosa and Vermillion. In contrast, all cases with lesions extending to the lip skin (10 cases) experienced hypopigmentation which resolved spontaneously within 3 months. No complications were observed in our cases during the follow-up period and no cases, during the follow-up period, showed regrowth of the treated lesions. We can conclude that, cryo-carboxy surgery is an effective safe new tool in the armamentarium of the treatment of infantile hemangiomas of the lips with successful results.

Recent Advances in Targeted Therapies for Infantile Hemangiomas.

Targeted therapy for infantile hemangiomas (IHs) has been extensively studied as they can concentrate drugs, increase therapeutic efficacy and reduce drug dosage. Meanwhile, they can extend drug release times, enhance drug stability, decrease dosing frequency, and improve patient compliance. Moreover, carriers made from biocompatible materials reduced drug immunogenicity, minimizing adverse reactions. However, current targeted formulations still face numerous challenges such as the non-absolute safety of carrier materials; the need to further increase drug loading capacity; the limitation of animal hemangioma models in fully replicating the biological properties of human infantile hemangiomas; the establishment of models for deep-seated hemangiomas with high incidence rates; and the development of more specific targets or markers. In this review, we provided a brief overview of the characteristics of IHs and summarized the past decade's advances, advantages, and targeting strategies of targeted drug delivery systems for IHs and discussed their applications in the treatment of IHs. Furthermore, the goal is to provide a reference for further research and application in this field.