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Propranolol combined with PDL clears infantile hemangioma


The combined use of propranolol and pulsed dye laser (PDL) resulted in more rapid and complete clearance of infantile hemangiomas than propranolol monotherapy, according to data presented at the 2012 annual meeting of the American Society for Laser Medicine and Surgery.

Key Points

"We found that patients who received both (propranolol and PDL) often had more complete clearance," says Kavitha Reddy, M.D., a procedural dermatology fellow at the Laser & Skin Surgery Center of New York. "The pulsed dye laser is effective in treating the superficial component of the hemangioma, and propranolol can leave behind a superficial component, so the two work well together."

Retrospective study

Treatment efficacy was evaluated by the level of hemangioma clearance observed (none, partial, near-complete, or complete). Dr. Reddy describes near-complete clearance as minimal superficial disease left behind. The level of clearance of the hemangioma was rated by blinded physician assessment of patient photographs.

Investigators also recorded length of treatment until complete or near-complete resolution was reached; length of propranolol treatment to reach near-complete or complete resolution; and the number of PDL sessions to reach near-complete or complete resolution.

There was complete or near-complete clearance in all nine patients who received concurrent, combination therapy, compared with only two of the five patients who received propranolol monotherapy (three of the propranolol only group having residual superficial disease).

Seven patients received propranolol followed by PDL. These patients each had remaining residual superficial hemangioma after propranolol treatment and were referred for PDL to clear the superficial component. All achieved near-complete or complete clearance after PDL treatments were complete.

Patients who received concurrent combination therapy reached complete or near-complete clearance after a mean 81 days of propranolol treatment, compared with 225 days for propranolol alone. Patients receiving propranolol followed by PDL also achieved near-complete or complete clearance more rapidly than those receiving propranolol alone (mean 160 days vs. 225 days for propranolol alone), but less rapidly than patients receiving concurrent combination therapy (mean 81 days for concurrent therapy vs. 160 days for sequential propranolol-PDL therapy).

While it appears preferable that patients be administered PDL concurrently with propranolol, the data show there remains an opportunity to treat any superficial component that remains after cessation of propranolol therapy. Many patients may continue to receive propranolol even after they've achieved clearance of the hemangioma, but the dose would typically be reduced, Dr. Reddy says.

Creating synergy

Roy Geronemus, M.D., medical director at the Laser & Skin Surgery Center of New York and the study's principal investigator, says combination therapy allows for a shorter course or reduced total dose of propranolol therapy.

"Our goal was to find some synergy between the two (treatments)," says Dr. Geronemus, clinical professor of dermatology at New York University Medical Center in New York. "We found more (synergy) than we had expected. We did not realize that we would get much more clearance with a combination of propranolol and PDL than with propranolol alone, and we did not expect we could shorten the amount of time that propranolol is necessary," he says.

Disclosures: Dr. Geronemus has been a consultant for Candela. Dr. Reddy reports no relevant financial interests.

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