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Infantile haemangiomas that failed treatment with propranolol: Clinical and histopathological features
Version of Record online: 6 JUN 2014
© 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Journal of Paediatrics and Child Health
Volume 50, Issue 8, pages 619–625, August 2014
How to Cite
Phillips, R. J., Lokmic, Z., Crock, C. M. and Penington, A. (2014), Infantile haemangiomas that failed treatment with propranolol: Clinical and histopathological features. Journal of Paediatrics and Child Health, 50: 619–625. doi: 10.1111/jpc.12600
Conflict of interest: None declared.
- Issue online: 1 AUG 2014
- Version of Record online: 6 JUN 2014
- Manuscript Accepted: 5 JAN 2014
- beta-2 adrenergic receptor;
To describe the clinical and histopathological characteristics of infantile haemangiomas that failed treatment with oral propranolol .
This study is a case series from the vascular birthmarks clinic at Royal Children's Hospital, Melbourne.
The patients for this study were infants who commenced treatment with oral propranolol before 6 months of age and who were treated for at least 4 months without a satisfactory result. For histology and immunohistochemistry, tissue from the four non-responding patients who subsequently underwent surgical excision was matched with four historical controls.
Based on medical record review and photographic assessments, infants were defined as having failed treatment with oral propranolol if the infantile haemangioma either continued to grow or showed 20% improvement or less. Tissue sections were examined for tissue structure, mast cells, sympathetic innervations and beta-2 adrenergic receptor expression, and the number of mast cells and beta-2 adrenergic positive cells.
From a group of 135 infants who met the inclusion criteria, 14 infants failed propranolol treatment. Eleven of these infants had focal facial haemangiomas. No difference was seen in tissue morphology, tissue innervations, beta-2 adrenergic receptor expression, cell number or mast cell distribution, and number between non-responding and control haemangiomas.
We report a treatment failure rate of 10%, which is higher than previously reported. Focal facial lesions failed to respond twice as frequently as other types of haemangioma. No histopathological reason was identified to indicate why some haemangiomas failed to respond.