Aesthetic Outcome of Propranolol vs Atenolol Treatment of Children with Infantile Haemangioma

Authors

  • Mireille M. Hermans Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Department of Dermatology – Center of Pediatric Dermatology; Vascular Anomaly Center Erasmus MC Rotterdam, the Netherlands
  • Corstiaan C. Breugem Department of Plastic, Reconstructive and Hand surgery, Amsterdam; Center for Vascular Anomalies Amsterdam University Medical Center;
  • Renske Schappin Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Department of Dermatology – Center of Pediatric Dermatology; Department of Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht
  • Emma Jonge Poerink Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Department of Dermatology – Center of Pediatric Dermatology
  • Elodie J. Mendels Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Department of Dermatology – Center of Pediatric Dermatology; Vascular Anomaly Center Erasmus MC Rotterdam, the Netherlands
  • Aviël Ragamin Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Department of Dermatology – Center of Pediatric Dermatology; Vascular Anomaly Center Erasmus MC Rotterdam, the Netherlands
  • Johannes M.P.J. Breur Department of Pediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Center Utrecht; UMCU Center for Vascular Anomalies Utrecht
  • Hester R. Langeveld Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Intensive Care and Department of Pediatric Surgery; Vascular Anomaly Center Erasmus MC Rotterdam
  • Martine F. Raphael Department of Pediatric Oncology, Emma Children’s Hospital, Amsterdam University Medical Center; Center for Vascular Anomalies Amsterdam
  • Peter C.J. de Laat Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Department of Pediatric Hemato-oncology; Vascular Anomaly Center Erasmus MC Rotterdam
  • Saskia N. de Wildt Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University medical center, Nijmegen; Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Intensive Care and Department of Pediatric Surgery
  • André B. Rietman Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Department of Child and Adolescent Psychology/Psychiatry
  • Suzanne G.M.A. Pasmans Department of Dermatology – Center of Pediatric Dermatology, Vascular Anomaly Center Rotterdam, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, NL-3015 GD Rotterdam, The Netherlands
  • Marlies de Graaf Department of Dermatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht; UMCU Center for Vascular Anomalies Utrecht

DOI:

https://doi.org/10.2340/actadv.v102.2021

Keywords:

Capillary hemangioma, Vascular tissue neoplasms, Vascular malformations, Adrenergic beta-antagonists, Esthetics, Cicatrix

Abstract

Infantile haemangiomas are common benign tumours of infancy, which can be treated effectively with beta-blockers such as propranolol and atenolol. Different types of beta-blockers may result in different long-term aesthetic outcomes. This study evaluated the difference in long-term aesthetic outcomes between infantile haemangiomas treated with either propranolol or atenolol, including the perspective of physicians, parents, and children. Children, aged ≥6 years, treated with propranolol or atenolol for infantile haemangioma during infancy, participated in this 2-centre cross-sectional study. The primary endpoint was change in appearance of the infantile haemangioma from pre-treatment to follow-up, using a physician-rated visual analogue scale (VAS). Secondary outcomes were the Patient Observer Scar Assessment Scale (physician- and parent-rated) and a VAS (child-rated), assessing the residual lesion. In total, 103 children (35 treated with propranolol, 68 with atenolol) were analysed. No differences were found between children treated with propranolol and children treated with atenolol on physician-rated VAS (p = 0.10) or any secondary outcomes. Physicians indicated a large aesthetic improve-ment from pre- treatment to follow-up. Physicians, parents and children were positive about the current state of the residual lesion. Minor sequelae were common (86%). These results, in combination with the favourable safety profile of atenolol, should be considered when choosing beta-blocker treatment for infantile haemangioma.

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References

Munden A, Butschek R, Tom WL, Marshall JS, Poeltler DM, Krohne SE, et al. Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies. Br J Dermatol 2014; 170: 907-913.

https://doi.org/10.1111/bjd.12804 DOI: https://doi.org/10.1111/bjd.12804

Dickison P, Christou E, Wargon O. A prospective study of infantile hemangiomas with a focus on incidence and risk factors. Pediatr Dermatol 2011; 28: 663-669.

https://doi.org/10.1111/j.1525-1470.2011.01568.x DOI: https://doi.org/10.1111/j.1525-1470.2011.01568.x

Anderson KR, Schoch JJ, Lohse CM, Hand JL, Davis DM, Tollefson MM. Increasing incidence of infantile hemangiomas (IH) over the past 35 years: correlation with decreasing gestational age at birth and birth weight. J Am Acad Dermatol 2016; 74: 120-126.

https://doi.org/10.1016/j.jaad.2015.08.024 DOI: https://doi.org/10.1016/j.jaad.2015.08.024

Chang LC, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, et al. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics 2008; 122: 360-367.

https://doi.org/10.1542/peds.2007-2767 DOI: https://doi.org/10.1542/peds.2007-2767

Bauland CG, Lüning TH, Smit JM, Zeebregts CJ, Spauwen PH. Untreated hemangiomas: growth pattern and residual lesions. Plast Reconstr Surg 2011; 127: 1643-1648.

https://doi.org/10.1097/PRS.0b013e318208d2ac DOI: https://doi.org/10.1097/PRS.0b013e318208d2ac

Couto RA, Maclellan RA, Zurakowski D, Greene AK. Infantile hemangioma: clinical assessment of the involuting phase and implications for management. Plast Reconstr Surg 2012; 130: 619-624.

https://doi.org/10.1097/PRS.0b013e31825dc129 DOI: https://doi.org/10.1097/PRS.0b013e31825dc129

Baselga E, Roe E, Coulie J, Munoz FZ, Boon LM, McCuaig C, et al. Risk factors for degree and type of sequelae after involution of untreated hemangiomas of infancy. JAMA Dermatol 2016; 152: 1239-1243.

https://doi.org/10.1001/jamadermatol.2016.2905 DOI: https://doi.org/10.1001/jamadermatol.2016.2905

Chang SJ, Qiao C, Chang L, Gao W, Jin Y, Ma G, et al. A 7-year follow-up study on untreated deep or mixed facial infantile hemangioma in East-Asian patients: when propranolol was not yet an option. J Dermatol 2019; 46: 962-966.

https://doi.org/10.1111/1346-8138.15080 DOI: https://doi.org/10.1111/1346-8138.15080

Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, et al. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics 2006; 118: 882-887.

https://doi.org/10.1542/peds.2006-0413 DOI: https://doi.org/10.1542/peds.2006-0413

Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008; 358: 2649-2651.

https://doi.org/10.1056/NEJMc0708819 DOI: https://doi.org/10.1056/NEJMc0708819

Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, Guibaud L, Baselga E, Posiunas G, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med 2015; 372: 735-746.

https://doi.org/10.1056/NEJMoa1404710 DOI: https://doi.org/10.1056/NEJMoa1404710

Raphael MF, de Graaf M, Breugem CC, Pasmans S, Breur J. Atenolol: a promising alternative to propranolol for the treatment of hemangiomas. J Am Acad Dermatol 2011; 65: 420-421.

https://doi.org/10.1016/j.jaad.2010.11.056 DOI: https://doi.org/10.1016/j.jaad.2010.11.056

Wang Q, Xiang B, Chen S, Ji Y. Efficacy and safety of oral atenolol for the treatment of infantile haemangioma: a systematic review. Australas J Dermatol 2019; 60: 181-185.

https://doi.org/10.1111/ajd.12966 DOI: https://doi.org/10.1111/ajd.12966

McAinsh J, Cruickshank JM. Beta-blockers and central nervous system side effects. Pharmacol Ther 1990; 46: 163-197.

https://doi.org/10.1016/0163-7258(90)90092-G DOI: https://doi.org/10.1016/0163-7258(90)90092-G

de Graaf M, Raphael MF, Breugem CC, Knol MJ, Bruijnzeel-Koomen CA, Kon M, et al. Treatment of infantile haemangiomas with atenolol: comparison with a historical propranolol group. J Plast Reconstr Aesthet Surg 2013; 66: 1732-1740.

https://doi.org/10.1016/j.bjps.2013.07.035

Ji Y, Chen S, Yang K, Zhang X, Zhou J, Li L, et al. Efficacy and safety of propranolol vs atenolol in infants with problematic infantile hemangiomas: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2021; 147: 599-607.

https://doi.org/10.1001/jamaoto.2021.0454 DOI: https://doi.org/10.1001/jamaoto.2021.0454

Liu Z, Wu C, Song D, Wang L, Li J, Wang C, et al. Atenolol vs. propranolol for the treatment of infantile haemangiomas: a systematic review and meta-analysis. Exp Ther Med 2020; 20: 1644-1652.

https://doi.org/10.3892/etm.2020.8842 DOI: https://doi.org/10.3892/etm.2020.8842

Abarzúa-Araya Á, Navarrete-Dechent CP, Heusser F, Retamal J, Zegpi-Trueba MS. Atenolol versus propranolol for the treat­ment of infantile hemangiomas: a randomized controlled study. J Am Acad Dermatol 2014; 70: 1045-1049.

https://doi.org/10.1016/j.jaad.2014.01.905 DOI: https://doi.org/10.1016/j.jaad.2014.01.905

Tanner JL, Dechert MP, Frieden IJ. Growing up with a facial hemangioma: parent and child coping and adaptation. Pediatrics 1998; 101: 446-452.

https://doi.org/10.1542/peds.101.3.446 DOI: https://doi.org/10.1542/peds.101.3.446

Yu Z, Cai R, Chang L, Qiu Y, Chen X, Chen Q, et al. Clinical and radiological outcomes of infantile hemangioma treated with oral propranolol: a long-term follow-up study. J Dermatol 2019; 46: 376-382.

https://doi.org/10.1111/1346-8138.14853 DOI: https://doi.org/10.1111/1346-8138.14853

Novoa M, Baselga E, Beltran S, Giraldo L, Shahbaz A, Pardo-Hernandez H, et al. Interventions for infantile haemangiomas of the skin. Cochrane Database Syst Rev 2018; 4: CD006545.

https://doi.org/10.1002/14651858.CD006545.pub3 DOI: https://doi.org/10.1002/14651858.CD006545.pub3

Duncan JAL, Bond JS, Mason T, Ludlow A, Cridland P, O'Kane S, et al. Visual analogue scale scoring and ranking: a suitable and sensitive method for assessing scar quality? Plast Reconstr Surg 2006; 118: 909-918.

https://doi.org/10.1097/01.prs.0000232378.88776.b0 DOI: https://doi.org/10.1097/01.prs.0000232378.88776.b0

de Graaf M, Raphael MF, Breugem CC, Knol MJ, Bruijnzeel-Koomen CAFM, Kon M, et al. Treatment of infantile haemangiomas with atenolol: comparison with a historical propranolol group. J Plast Reconstr Aesthet Surg 2013; 66: 1732-1740.

https://doi.org/10.1016/j.bjps.2013.07.035 DOI: https://doi.org/10.1016/j.bjps.2013.07.035

van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP. Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale. Plast Reconstr Surg 2005; 116: 514-522.

https://doi.org/10.1097/01.prs.0000172982.43599.d6 DOI: https://doi.org/10.1097/01.prs.0000172982.43599.d6

UMC Utrecht Wilhelmina Kinderziekenhuis. Faces pain scale. [cited 2021 Jul 14]; Available from: https://www.hetwkz-kind.nl/obzf/narcose-na-de-ingreep-pijn/pijnliniaaljpg/

Tomlinson D, von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 2010; 126: 1168-1198.

https://doi.org/10.1542/peds.2010-1609 DOI: https://doi.org/10.1542/peds.2010-1609

Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988; 124: 869-871. DOI: https://doi.org/10.1001/archderm.124.6.869

https://doi.org/10.1001/archderm.1988.01670060015008 DOI: https://doi.org/10.1001/archderm.1988.01670060015008

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77-101.

https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa

Garg S, Hassan A, Patel A, Koko D, Varghese J, Ellis M, et al. Ethnic differences in patient perception of the quality-of-life impact of scars. Wound Healing Society Virtual Webinar [serial online] 2021 May 19 [cited 2022 May 22]: p. A46. Available from: URL:https://woundheal.org/Meeting/multimedia/files/2021/Journal-Abstracts.pdf.

Kim S, Choi TH, Liu W, Ogawa R, Suh JS, Mustoe TA. Update on scar management: guidelines for treating Asian patients. Plast Reconstr Surg 2013; 132: 1580-1589.

https://doi.org/10.1097/PRS.0b013e3182a8070c DOI: https://doi.org/10.1097/PRS.0b013e3182a8070c

Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr 2007; 150: 291-294.

https://doi.org/10.1016/j.jpeds.2006.12.003 DOI: https://doi.org/10.1016/j.jpeds.2006.12.003

Lin P-F, Chen F-C, Chen J-Y, Jiang C-H. Aesthetic outcome of intralesional injection of lauromacrogol as a single-agent treatment for uncomplicated infantile hemangiomas: a long-term follow-up study. J Dermatol 2020; 47: 1119-1125.

https://doi.org/10.1111/1346-8138.15473 DOI: https://doi.org/10.1111/1346-8138.15473

Chang SJ, Yu W, Gu Y, Han Y, Shang Y, Chang L, et al. Location of infantile hemangioma is a predictor of volumetric sequelae after involution. J Dermatol 2019; 46: 371-375.

https://doi.org/10.1111/1346-8138.14847 DOI: https://doi.org/10.1111/1346-8138.14847

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Published

2022-10-11

How to Cite

Hermans, M. M., Breugem, C. C., Schappin, R., Jonge Poerink, E., Mendels, E. J., Ragamin, A., Breur, J. M., Langeveld, H. R., Raphael, M. F., de Laat, P. C., de Wildt, S. N., Rietman, A. B., Pasmans, S. G., & de Graaf, M. (2022). Aesthetic Outcome of Propranolol vs Atenolol Treatment of Children with Infantile Haemangioma. Acta Dermato-Venereologica, 102, adv00788. https://doi.org/10.2340/actadv.v102.2021

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Vol. 102 (2022)

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Copyright (c) 2022 Mireille M. Hermans, Corstiaan C. Breugem, Renske Schappin, Emma Jonge Poerink, Elodie J. Mendels, Aviël Ragamin, Johannes M.P.J. Breur, Hester R. Langeveld, Martine F. Raphael, Peter C.J. de Laat, Saskia N. de Wildt, André B. Rietman, Suzanne G.M.A. Pasmans, Marlies de Graaf

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