Higher Doses of Oral Propranolol for Resistant Infantile Haemangiomas
DOI:
https://doi.org/10.2340/actadv.v106.43152Keywords:
resistance, infantile haemangioma, propranololAbstract
Propranolol at 3 mg/kg/day is considered the gold standard for treating infantile haemangiomas. Nevertheless, the management of propranolol-resistant infantile haemangiomas (PRIH) remains challenging. This national multicentre retrospective observational study includes all PRIHs who received propranolol > 3 mg/kg/day. The study aims to investigate the pattern of PRIHs, assess the effects and tolerance of a higher dose, and identify predictive factors for response to this increased dosage. Fifteen PRIHs were included (prevalence 0.45%), mainly females, and most presented with a large lesion. Three distinct patterns of PRIH were identified: facial segmental lesions (47%), facial localized lesions with a subcutaneous component (40%), and body-localized mixed and ulcerated lesions (13%). Six PRIH (40%) responded to the higher dose (from 3.75 to 4 mg/kg/day). Three predictive factors were significantly associated with a good response: IGIc-IH1 at the end of 3 mg/kg/day regimen (OR = 22.9, 95% CI [1.2–1844.1]), a duration of 3.5 months or more at 3 mg/kg/day (OR = 17.5, 95% CI [1.22–250.37]), and 7 months or more at > 3 mg/kg/day (OR = 17.5, 95% CI [1.22–250.37]). Tolerance was generally good, although one patient experienced severe hypotension during dose escalation. Propranolol doses higher than 3 mg/kg/day may therefore be considered a potential treatment option for PRIHs.
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Copyright (c) 2026 Isabelle Dreyfus, Charlène Dénos, Olivia Boccara, Sébastien Barbarot, Véronique Gagey-Caron, Annabel Maruani, Juliette Miquel, Catherine Droitcourt, Michèle Bigorre, Ludovic Martin, Christine Leauté-Labrèze, Juliette Mazereeuw-Hautier
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