Comparative Study of the Use of Beta Blocker and Oral Corticosteroid in the Treatment of Infantile Hemangioma

Infantile Hemangioma (IH) is infancy's most common vascular tumor of infancy and most frequent benign neoplasm. Treatment of IHs is indicated for approximately 10 to 20% of the cases. Two groups can be defined amongst indications for treatment: patients with absolute indication for treatment and patients with relative indication for treatment. Absolute or emergency indications comprise function or life threatening situations such as obstruction of airways, obstruction of vision, congestive heart failure, hepatic and coagulation problems. The following are considered relative indications: cases of large and disfiguring facial hemangiomas; locations that can result in a deformity and/ or permanent scar (nose, ear, lip, glabellar area); extensive face hemangiomas, mainly when there is dermal damage (more probable to scar); local complications such as ulceration, infection and bleeding as well as small hemangiomas in exposed areas (hands and face), mainly if pedunculated due to its ease of excision2,7. Treatment modalities vary according to the extension, location, presence of complications and the evolutional phase. A combination of various treatments is possible. Beta blockers are being used in children for approximately 40 years, with proven clinical safety and no cases of death or cardiovascular disease resulting from its direct use. Recently it was reported the use of beta blockers (propanolol) for IH treatment, with significant reduction of tumor volume after introduction of the beta blocker, in a short period of time, with stable results after the end of treatment, which suggested evidences of the benefits of this drug in the tumor treatment The proposal of this study is to assess the use of propanolol in IH treatment, quantifying its effectiveness and safety under continuous monitoring and comparing it to the use of oral corticosteroid. The investigators propose the assessment of the betablockers' use in comparison to the use of corticosteroids in infants with IH in the proliferative or involuting phases, with indication for clinical treatment, and that are not alarming nor urgent; in other words, the current relative indications for treatment.

Sex

All

Minimum age

10 Days

Maximum age

2 Years

Inclusion Criteria:

* Patients with ages up to 2 years;
* Clinically diagnosed hemangioma, in proliferative or involutive phase, with relative indication for clinical treatment, as itemized:
* lesion causing alteration of regional anatomy with no systemic or functional damage and with a diameter greater than 1 centimeter, or
* lesion causing aesthetic deformity, or
* lesion causing local repetitive complications such as ulceration, bleeding or local infection, or
* lesion causing partial damage of orifices, or
* lesion causing psychological compromise.
* Absence of cardiopathy (normal physical examination, anamnesis, echocardiography, electrocardiography and thoracic radiography);
* Informed consent signed by responsible parties

Exclusion Criteria:

* Hemangioma with absolute indication for treatment, presenting a risk to function or life;
* Patients with previous treatment for infantile hemangiomas;
* Cardiac disease;
* Pulmonary disease (asthma, bronchiolitis,bronchopulmonary dysplasias)
* Raynaud syndrome;
* Pheochromocytoma;
* Altered echocardiography, even if asymptomatic

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