Background: Infantile hemangioma is the most common tumor of infancy. There are recent reports of the efficacy of propranolol in the treatment of these hemangiomas. Nasal tip hemangiomas pose a particularly sensitive concern aesthetically and functionally. The treatment of nasal tip hemangiomas is controversial. We assessed the effect of propranolol therapy in hemangiomas of the nasal tip. Objectives: To evaluate the response of nasal tip hemangiomas to systemic propranolol. Methods: During 2008-2010 ten infant with nasal tip hemangiomas presented to our tertiary care center. All underwent comprehensive evaluation by a multidisciplinary team and were then treated with oral propranolol at 2 mg/kg/day, with continuous clinical follow-up until age 14-16 months, or in older infants until the proliferative phase resolved. Results: Eight patients demonstrated good clinical improvement. Two patients had partial improvement. One patient discontinued treatment due to wheezing. Three patients had mild sleep disturbance which did not warrant discontinuation of treatment. No rebound was noticed after cessation of treatment. Limitations: Children presented by referral at variable ages. It is possible that routine initiation of propranolol in neonates at the first sign of nasal hemangioma may reduce the required treatment duration or dose. Conclusions: Early treatment of hemangiomas of the nasal tip with propranolol prevents lesion proliferation, reduces lesion volume, and prevents nasal and facial deformation. Propranolol appears to be a safe and effective treatment. Its efficacy and safety profiles, relative to other accepted therapies, suggest that it should be considered as the first-line treatment when intervention is required.

Keywords:
Nasal tip hemangiomas, Children, Propranolol
1.
Frieden IJ, Haggstrom AN, Drolet BA, Mancini AJ, Friedlander SF, Boon L, et al: Infantile hemangiomas: current knowledge, future directions. Proceedings of a research workshop on infantile hemangiomas, April 7-9, 2005, Bethesda, Maryland, USA. Pediatr Dermatol 2005;22:383-406.
2.
Enjolras O: Classification and management of the various superficial vascular anomalies: hemangiomas and vascular malformations. J Dermatol 1997;24:701-710.
3.
Waner M, North PE, Scherer KA, Frieden IJ, Waner A, Mihm MC Jr: The nonrandom distribution of facial hemangiomas. Arch Dermatol 2003;139:869-875.
4.
Tanner JL, Dechert MP, Frieden IJ: Growing up with a facial hemangioma: parent and child coping and adaptation. Pediatrics 1998;101:446-452.
5.
Bruckner AL, Frieden IJ: Hemangiomas of infancy. J Am Acad Dermatol 2003;48:477-493, quiz 494-496.
6.
Frieden IJ, Eichenfield LF, Esterly NB, Geronemus R, Mallory SB: Guidelines of care for hemangiomas of infancy. American Academy of Dermatology Guidelines/Outcomes Committee. J Am Acad Dermatol 1997;37:631-637.
7.
Cho S, Lee SY, Choi JH, Sung KJ, Moon KC, Koh JK: Treatment of ‘Cyrano' angioma with pulsed dye laser. Dermatol Surg 2001;27:670-672.
8.
Hamou C, Diner PA, Dalmonte P, Vercellino N, Soupre V, Enjolras O, et al: Nasal tip haemangiomas: guidelines for an early surgical approach. J Plast Reconstr Aesthet Surg 2010;63:934-939.
9.
Faguer K, Dompmartin A, Labbe D, Barrellier MT, Leroy D, Theron J: Early surgical treatment of Cyrano-nose haemangiomas with Rethi incision. Br J Plast Surg 2002;55:498-503.
10.
Hochman M, Mascareno A: Management of nasal hemangiomas. Arch Facial Plast Surg 2005;7:295-300.
11.
Leaute-Labreze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taieb A: Propranolol for severe hemangiomas of infancy. N Engl J Med 2008;358:2649-2651.
12.
Sans V, de la Roque ED, Berge J, Grenier N, Boralevi F, Mazereeuw-Hautier J, et al: Propranolol for severe infantile hemangiomas: follow-up report. Pediatrics 2009;124:e423-e431.
13.
Waner M, Kastenbaum J, Scherer K: Hemangiomas of the nose: surgical management using a modified subunit approach. Arch Facial Plast Surg 2008;10:329-334.
14.
McCarthy JG, Borud LJ, Schreiber JS: Hemangiomas of the nasal tip. Plast Reconstr Surg 2002;109:31-40.
15.
Denk MJ, Ajkay N, Yuan X, Rosenblum RS, Freda N, Magee WP Jr: Surgical treatment of nasal hemangiomas. Ann Plast Surg 2002;48:489-494, discussion 494-495.
16.
van der Meulen JC, Gilbert M, Roddi R: Early excision of nasal hemangiomas: the L-approach. Plast Reconstr Surg 1994;94:465-473, discussion 474-475.
17.
Pitanguy I, Machado BH, Radwanski HN, Amorim NF: Surgical treatment of hemangiomas of the nose. Ann Plast Surg 1996;36:586-592, discussion 592-593.
18.
Bennett ML, Fleischer AB Jr, Chamlin SL, Frieden IJ: Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation. Arch Dermatol 2001;137:1208-1213.
19.
Boon LM, MacDonald DM, Mulliken JB: Complications of systemic corticosteroid therapy for problematic hemangioma. Plast Reconstr Surg 1999;104:1616-1623.
20.
Thomson HG, Lanigan M: The Cyrano nose: a clinical review of hemangiomas of the nasal tip. Plast Reconstr Surg 1979;63:155-160.
21.
Eivazi B, Cremer HJ, Mangold C, Teymoortash A, Wiegand S, Werner JA: Hemangiomas of the nasal tip: an approach to a therapeutic challenge. Int J Pediatr Otorhinolaryngol 2011;75:368-375.
22.
Bagazgoitia L, Torrelo A, Gutierrez JC, Hernandez-Martin A, Luna P, Gutierrez M, et al: Propranolol for infantile hemangiomas. Pediatr Dermatol 2011;28:108-114.
23.
Bagazgoitia L, Hernandez-Martin A, Torrelo A: Recurrence of infantile hemangiomas treated with propranolol. Pediatr Dermatol 2011;28:658-662.
24.
Price CJ, Lattouf C, Baum B, McLeod M, Schachner LA, Duarte AM, et al: Propranolol vs corticosteroids for infantile hemangiomas: a multicenter retrospective analysis. Arch Dermatol 2011;147:1371-1376.
25.
Cavelli R, Buffon RB, de Souza AM, Gelmetti C: Tumor lysis syndrome after propranolol therapy in ulcerative infantile hemangioma: rare complication or incidental finding? Dermatology 2012;224:106-109.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.