Farmacoriflessioni
Propranololo ed emangiomi
Propranolol and haemangiomas
Irene Berti1, Matteo Pavan1, Giulia Paloni1, Cristina Bibalo1, Federico Marchetti2, Alessandro Ventura1
1Clinica Pediatrica, IRCCS Materno-Infantile “Burlo Garofolo”, Università di Trieste
2UOC di Pediatria e Neonatologia, Azienda Ospedaliera di Ravenna
Dicembre 2013 - pagg. 651 -657
Abstract
Infantile Haemangiomas (IE) are common benign tumours, affecting around 10% of the
new borns. Natural history goes towards a spontaneous regression in most cases, although
in long times (years) and sometimes with some imperfect outcome. Propranolol has
been recently proposed as a very effective treatment for IE, without relevant side effects.
The number of children treated is increasing very quickly, but currently there are neither
uniform guidelines nor shared protocols. Basing on available data it can be said that propranolol
is very safe and the current recommendations for cardiovascular monitoring may
probably be simplified. For very superficial lesions and at the very beginning, topical timolol
can be used successfully.
Classificazione MeSH
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Bibliografia
1. Léauté-Labrèze C, Dumas de la Roque E,
Hubiche T, et al. Propranolol for severe hemangiomas
in infancy. N Engl J Med 2008;358:
2649-51.
2. Marsciani A, Pericoli R, Alaggio R, et al.
Massive response of severe infantile hepatic
emangioma to propranolol. Pediatr Blood
Cancer 2010;54:176.
3. Haider KM, Plager DA, Neely DE, et al.
Outpatient treatment of periocular infantile
hemangiomas with oral propranolol. J AAPOS
2010;14:251-6.
4. Sans V, De la Roque DE, Berge J, et al. Propranolol
for severe infantile hemangiomas: follow-
up report. Pediatrics 2009;124:e423-e431.
5. Manunza F, Syed S, Laguda B, et al. Propranolol
for complicated infantile haemangiomas:
a case series of 30 infants. Br J Dermatol
2010;162:466-8.
6. Kilcline C, Frieden IJ. Infantile hemangiomas:
how common are they? A systematic
review of the medical literature. Pediatr Dermatol
2008;25:168-73.
7. Frieden IJ, Haggstrom A, Drolet BA, et al.
Infantile hemangiomas: current knowledge,
future directions: proceedings of a research
workshop on infantile hemangiomas. Pediatr
Dermatol 2005;22:383-406.
8. Haggstrom AN, Drolet BA, Baselga E, et al.
Prospective study of infantile hemangiomas:
clinical characteristics predicting complications
and treatment. Pediatrics 2006;118:882-7.
9. Mazzotta F, Troccoli T, Pisani V, Colonna V,
Bonifazi E. Precursori di emangioma. Eur J
Pediatr Dermatol 2008;18:113-28.
10. Bruckner AL, Frieden IJ. Hemangiomas of
infancy. J Am Acad Dermatol 2003;48:477-93.
11. Storch CH, Hoeger PH. Propranolol for infantile
haemangiomas: insights into the molecular
mechanisms of action. Br J Dermatol
2010;163:269-74.
12. Margileth AM, Museles M. Cutaneous hemangiomas
in children: diagnosis and conservative
management. JAMA 1965;194:523-
6.
13. Schwartz RA, Sidor MI, Musumeci ML, et
al. Infantile haemangiomas: a challenge in
paediatric dermatology. J Eur Acad Dermatol
Venereol 2010;24:631-38.
14. Chamlin SL, Haggstrom AN, Drolet BA, et
al. Multicenter prospective study of ulcerated
hemangiomas. J Pediatr 2007;151:484-9.
15. Tanner JL, Dechert MP, Frieden IJ. Growing
up with a facial hemangioma: parent and
child coping and adaptation. Pediatrics 1998;
101:446-52.
16. Kushner BJ. Infantile orbital hemangiomas.
Int J Pediatr 1990;5:249-57.
17. Buckmiller LM, Munson PD, Dyamenahalli
U, et al. Propranolol for infantile hemangiomas:
early experience at a tertiary vascular
anomalies center. Laryngoscope 2010;120:
676-81.
18. Greenberger S, Boscolo E, Adini I, Mulliken
JB, Bischoff J. Corticosteroid suppression
of VEGF-A in infantile hemangioma-derived
stem cells. N Engl J Med 2010;362:1005-
13.
19. Bennett ML, Fleischer AB, Chamlin SL,
Frieden IJ. Oral corticosteroid use is effective
for cutaneous hemangiomas: an evidencebased
evaluation. Arch Dermatol 2001;137:
1208-13.
20. Ezekowitz RAB, Phil CBD, Mulliken JB,
Folkman J. Interferon alfa-2a therapy for lifethreatening
hemangiomas of infancy. N Engl J
Med 1992;326:1456-63.
21. Enjolras O, Breviere GM, Roger G, et al.
Vincristine treatment for function- and lifethreatening
infantile hemangioma. Arch Pediatr
2004;11:99-107.
22. Burns AJ, Navarro JA. Role of laser therapy
in pediatric patients. Plast Reconstr Surg
2009;124:82e-92e.
23. Faurschou A, Olsen AB, Leonardi-Bee J,
Haedersdal M. Lasers or light sources for
treating port-wine stains. Cochrane Database
Syst Rev 2011;11:CD007152.
24. Daramola OO, Chun RH, Nash JJ, et al.
Surgical treatment of infantile hemangioma in
multidisciplinary vascular anomalies clinic.
Int J Pediatr Otorhinolaryngol 2011;75:1271-
4.
25. Marqueling AL, Vikash O, Frieden IJ,
Puttgen KB. Propranolol and infantile hemangiomas
four years later: a systematic review.
Pediatr Dermatol 2013:30;182-91.
26. Starkey E, Shahidullah H. Propranolol for
infantile haemangiomas: a review. Arch Dis
Child 2011;96:890-3.
27. Lawley LP, Siegfried E, Todd JL. Propranolol
treatment for hemangioma of infancy:
risks and recommendations. Pediatr Dermatol
2009;26:610-4.
28. Fredriksson JM, Lindquist JM, Bronnikov
GE, Nedergaard J. Norepinephrine induces
vascular endothelial growth factor gene expression
in brown adipocytes through a betaadrenoreceptor/
cAMP/protein kinse A pathway
involving Src but independently of Erk1/
2. J Biol Chem 2000;275:13802-11.
29. Zhang D, Ma Q, Shen S, et al. Inhibition of
pancreatic cancer cell proliferation by propranolol
occurs through apoptosis induction: the
study of beta-adrenoceptor antagonist’s anticancer
effect in pancreatic cancer cell. Pancreas
2009;38:94-100.
30. Zvulunov A, McCuaig C, Frieden IJ, et al.
Oral propranolol therapy for infantile hemangiomas
beyond the proliferation phase: a multicentric
retrospective study. Pediatr Dermatol
2011;28:94-8.
31. Chang LC, Haggstrom AN, Drolet BA, et
al. Growth characteristics of infantile hemangiomas:
implications for management. Pediatrics
2008;122:360-7.
32. Hogeling M, Adams S, Wargon O. A randomized
controlled trial of propranolol for infantile
hemangiomas. Pediatrics 2011;128:
e259-66.
33. Shehata N, Powell J, Dubois J, et al. Late
rebound in Infantile Hemangioma after Cessation
of Oral Propranolol. Pediatr Dermatol
2013;30:587-91.
34. Stoschitzky K, Sakotnik A, Lercher P, et al.
Influence of beta-blockers on melatonin release.
Eur J Clin Pharmacol 1999;55:111-5.
35. Holland KE, Frieden IJ, Frommelt PC, et
al. Hypoglycemia in children taking propranolol
for the treatment of infantile hemangioma.
Arch Dermatol 2010;146:775-8.
36. Kallen RJ, Mohler JH, Lin HL. Hypoglycemia:
a complication of treatment of hypertension
with propranolol. Clin Pediatr (Phila)
1980;19:567-8.
37. Semkova K, Kazandjieva J. Topical timolol
melate for treatment of infantile hemangiomas:
preliminary results of a prospective
study. Clin Exp Dermatol 2013;38:143-6.
38. Maguiness SM, Frieden IJ. Management
of difficult infantile hemangiomas. Arch Dis
Child 2012;97:266-71.
39. Chakkittakandiyil A, Phillips R, Frieden IJ,
et al. Timolol melate 0.5% or 0.1% gel-forming
solution for infantile hemangiomas: a retrospective,
multicenter, cohort study. Pediatr
Dermatol 2012;29:28-31.
40. Ventura A. Ti piace vincere facile? Ovvero:
propranololo contro placebo nell’emangiomatosi.
Medico e Bambino 2011;30:485.
Corrispondenza: irene.berti@burlo.trieste.it
