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Pediatrics. 2016 Apr;137(4). pii: e20151754. doi: 10.1542/peds.2015-1754. Epub 2016 Mar 7.

Rebound Growth of Infantile Hemangiomas After Propranolol Therapy.

Author information

1
Departments of Dermatology and sonal.shah@ucsf.edu.
2
Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain;
3
Division of Dermatology (Pediatrics), CHU Sainte-Justine, University of Montreal, Montreal, Canada;
4
Department of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Canada;
5
Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires St Luc, Brussels, Belgium;
6
Departments of Dermatology and Pediatrics, Columbia University, New York, New York;
7
Departments of Dermatology and Pediatrics, Indiana University, School of Medicine, Indianapolis, Indiana;
8
Department of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio;
9
Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin;
10
Division of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; and.
11
Department of Dermatology, National Institute of Pediatrics, Mexico City, Mexico.
12
Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California;
13
Departments of Dermatology and.

Abstract

BACKGROUND AND OBJECTIVES:

Propranolol is first-line therapy for problematic infantile hemangiomas (IHs). Rebound growth after propranolol discontinuation is noted in 19% to 25% of patients. Predictive factors for rebound are not completely understood and may alter the management approach. The goal of the study was to describe a cohort of patients with IHs treated with propranolol and to identify predictors for rebound growth.

METHODS:

A multicenter retrospective cohort study was conducted in patients with IHs treated with propranolol. Patient demographic characteristics, IH characteristics, and specifics of propranolol therapy were obtained. Episodes of rebound growth were recorded. Patients' responses to propranolol were evaluated through a visual analog scale.

RESULTS:

A total of 997 patients were enrolled. The incidence of rebound growth was 231 of 912 patients (25.3%). Mean age at initial rebound was 17.1 months. The odds of rebound among those who discontinued therapy at <9 months was 2.4 (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.3 to 4.5; P = .004) compared with those who discontinued therapy between 12 to 15 months of life. Female gender, location on head and neck, segmental pattern, and deep or mixed skin involvement were associated with rebound on univariate analysis. With multivariate analysis, only deep IHs (OR: 3.3; 95% CI: 1.9 to 6.0; P < .001) and female gender (OR: 1.7; 95% CI: 1.1 to 2.6; P = .03) were associated. Of those with rebound growth, 83% required therapeutic modification including 62% of patients with modifications in their propranolol therapy.

CONCLUSIONS:

Rebound growth occurred in 25% of patients, requiring modification of systemic therapy in 15%. Predictive factors for rebound growth included age of discontinuation, deep IH component, and female gender. Patients with these predictive factors may require a prolonged course of therapy.

PMID:
26952504
DOI:
10.1542/peds.2015-1754
[Indexed for MEDLINE]
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