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      Propranolol in the Treatment of Infantile Hemangiomas

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          Abstract

          Propranolol, as the first generation of β-blocker family, was initially introduced in the clinical application for tachycardia and hypertension in the 1960s. However, the occasional discovery of propranolol in the involution of infantile hemangiomas (IHs) brought us a new perspective. IHs are the most common infantile tumor, affecting 4–10% newborns. So far, oral propranolol is the first-line medication for IHs treatment. At the same time, local injection and topical propranolol are developing. Despite the worldwide application, the precise mechanism of propranolol of IHs has not been completely studied. In this article, we reviewed and summarized the current information on pharmacology, mechanism, efficacy, and adverse effects of propranolol. Novel design of biomaterials and bioactive molecules are needed for new treatment and ideal pathway to attain the minimal effective treatment concentration and eliminate the adverse effects.

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          A randomized, controlled trial of oral propranolol in infantile hemangioma.

          Oral propranolol has been used to treat complicated infantile hemangiomas, although data from randomized, controlled trials to inform its use are limited.
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            Propranolol for severe hemangiomas of infancy.

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              Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action.

              Infantile haemangiomas (IH) are the most common benign tumours of infancy. Although most IH are innocuous and 85-90% regress spontaneously, some may become life- or function-threatening and require immediate treatment. Previous standard therapeutic options include physical measures (laser surgery, cryosurgery) and systemic corticosteroids, in severe cases also vincristine, alpha-interferon or cyclophosphamide, all bearing the risk of serious side-effects. Oral propranolol is a very recent therapeutic option for complicated IH with impressive efficacy and generally good tolerance. The effects of propranolol on IH were discovered by chance, and very little is known about its mechanisms of action in IH. Here we present a summary of current knowledge of how propranolol interferes with endothelial cells, vascular tone, angiogenesis and apoptosis. Early, intermediate and long-term effects of propranolol on IH can be attributed to three different pharmacological targets. Early effects (brightening of the haemangioma surface within 1-3 days after start of therapy) are attributable to vasoconstriction due to decreased release of nitric oxide. Intermediate effects are due to the blocking of proangiogenic signals (vascular endothelial growth factor, basic fibroblast growth factor, matrix metalloproteinase 2/9) and result in growth arrest. Long-term effects of propranolol are characterized by induction of apoptosis in proliferating endothelial cells, and result in tumour regression.
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                Author and article information

                Journal
                Clin Cosmet Investig Dermatol
                Clin Cosmet Investig Dermatol
                ccid
                ccid
                Clinical, Cosmetic and Investigational Dermatology
                Dove
                1178-7015
                03 September 2021
                2021
                : 14
                : 1155-1163
                Affiliations
                [1 ]Department of Plastic Surgery, First Hospital of China Medical University , Shenyang, Liaoning Province, People’s Republic of China
                Author notes
                Correspondence: Chenchao Wang Department of Plastic Surgery, First Hospital of China Medical University , 155 North Nanjing Street, Shenyang, 110001, Liaoning Province, People’s Republic of ChinaTel +86-13842000361Fax +86-24-83282592 Email ccwang@cmu.edu.cn
                Author information
                http://orcid.org/0000-0001-9094-1602
                Article
                332625
                10.2147/CCID.S332625
                8423716
                6eed6d23-63fc-456e-ae1a-77ad7c52590c
                © 2021 Tan et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 10 August 2021
                : 24 August 2021
                Page count
                Figures: 0, Tables: 6, References: 92, Pages: 9
                Categories
                Review

                Dermatology
                infantile hemangiomas,propranolol,treatment
                Dermatology
                infantile hemangiomas, propranolol, treatment

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