First-line drugs for the systemic treatment of infantile hemangioma: propranolol

Infantile haemangiomas (IH) are the most common benign tumors of infancy, with a prevalence of up to 10% in Caucasians. Although 85-90% of IH regress spontaneously by the age of 7-10 years, some hemangiomas require prompt treatment because they are life-threatening and affect the function of the body. Previous standard treatments included physical therapy (laser surgery, cryosurgery) and systemic application of glucocorticoids, with severe cases requiring vincristine, alpha-interferon and cyclophosphamide, but these therapies often caused severe adverse effects in infants. Glucocorticoids have been used to treat IH for more than 30 years and have been the first-line agents in the systemic treatment of IH. However, the dose of glucocorticoids for IH is relatively high, with the standard dosage of prednisone being 2-3 mg/kg・d, and sometimes very high doses of 3-5 mg/kg・d are required to control the growth of IH. However, glucocorticosteroids are not effective in fast-growing IH, and IH grows rebound after discontinuation of the drug, with significant side effects, including growth inhibition in infants and children and suppression of the hypothalamic-pituitary-adrenal (HPA) axis, as well as impairment of planned immunity in infants and children due to immunosuppression. Compared with glucocorticoids, propranolol has been recognized as a new first-line drug for the treatment of IH because of its significant and rapid efficacy, mild and manageable adverse effects, and the absence of rebound growth of hemangiomas after discontinuation of the drug.