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BSPD guidelines for treatment of IH with propranolol

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Abstract

Infantile haemangiomas (IH) are common birthmarks in babies consisting of dilated blood vessels. They are also known as strawberry naevi. Most of them grow for a few months, then gradually shrink spontaneously over a period of months or years. However, in about 15% of cases they can cause serious functional problems when they involve important structures such as the eye, ear, mouth, nose and the peri‐anal area. In addition they can sometimes resolve, but leaving significant disfigurement. In 2008 it was reported that the beta‐blocker drug propranolol, given orally (by mouth), was very effective in causing these birthmarks to shrink rapidly. This paper is designed to provide guidance to doctors on how best to administer propranolol to children with IH. Developing the guidelines involved several stages: an international survey of current practice in eight European countries; a systematic review of the literature; collecting current local guidelines from 19 centres leading to the generation of 70 statements. These 70 statements were then scrutinised by 19 experts from relevant specialities (Dermatology, Paediatrics, Paediatric Cardiology and Paediatric ENT surgery). Using an established research protocol, agreement was reached by these experts on 47 statements covering eight categories. These categories include: indications for starting propranolol (i.e. it which situations it should be used); contraindications (i.e. in which situations it should not be used); pre‐treatment tests needed; initiation of treatment; monitoring during treatment and when to stop treatment. They also cover treatment of children with additional medical complications.Although these guidelines are UK‐based, the authors hope that they will be useful in other European countries also.
PLAIN LANGUAGE SUMMARY BJD
British Journal of Dermatology
BSPD guidelines for treatment of IH with propranolol
L. Solman, M. Glover, P.E. Beattie, H. Buckley, S. Clark, J.E. Gach, A. Giardini, I. Helbling, R.J. Hewitt,
B. Laguda, S.M. Langan, A.E. Martinez, R. Murphy, L. Proudfoot, J. Ravenscroft, H. Shahidullah, L. Shaw,
S.B. Syed, L. Wells and C. Flohr
This summary relates to https://doi.org/10.1111/bjd.16779
British Journal of Dermatology,179, 582589, September 2018
Summary
Infantile haemangiomas (IH) are common birthmarks in babies consisting of dilated blood vessels. They are also
known as strawberry naevi. Most of them grow for a few months, then gradually shrink spontaneously over a period
of months or years. However, in about 15% of cases they can cause serious functional problems when they involve
important structures such as the eye, ear, mouth, nose and the peri-anal area. In addition they can sometimes
resolve, but leaving significant disfigurement. In 2008 it was reported that the beta-blocker drug propranolol, given
orally (by mouth), was very effective in causing these birthmarks to shrink rapidly. This paper is designed to provide
guidance to doctors on how best to administer propranolol to children with IH. Developing the guidelines involved
several stages: an international survey of current practice in eight European countries; a systematic review of the lit-
erature; collecting current local guidelines from 19 centres leading to the generation of 70 statements. These 70
statements were then scrutinised by 19 experts from relevant specialities (Dermatology, Paediatrics, Paediatric Cardi-
ology and Paediatric ENT surgery). Using an established research protocol, agreement was reached by these experts
on 47 statements covering eight categories. These categories include: indications for starting propranolol (i.e. it
which situations it should be used); contraindications (i.e. in which situations it should not be used); pre-treatment
tests needed; initiation of treatment; monitoring during treatment and when to stop treatment. They also cover treat-
ment of children with additional medical complications.Although these guidelines are UK-based, the authors hope
that they will be useful in other European countries also.
©2018 British Association of Dermatologistse146 British Journal of Dermatology (2018) 179, ppe146
Article
Infantile haemangiomas (IH) are common benign vascular neoplasms of infancy. Natural history follows a characteristic pattern - proliferation, stabilisation, and involution. Most IH remain uncomplicated. Watchful expectancy will suffice for this group. Segmental type of IH over face and lower back can be associated with extra cutaneous abnormalities. A small subset of IH gets complicated with risk of functional impairment, cosmetic disfigurement, or ulceration. Systemic treatment is required for this selective group to hasten natural involution and prevent secondary complications. Oral propranolol has revolutionised the management of IH and is now the first line systemic treatment. Topical beta blockers have also been used increasingly in the management of superficial localised lesions. Other systemic options include oral steroids, vincristine, interferon but all of these have a limited role due to adverse side effects. A multidisciplinary approach with the team of paediatricians, paediatric dermatologists and other specialists is essential in management of complicated IH.
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