Oral propranolol versus cryotherapy in the management of cutaneous hemangioma in infants and children

Objective: The aim of the study was to evaluate the effi cacy, adverse effects, and success rate of oral propranolol versus liquid nitrogen oxide gas cryotherapy in the management of cutaneous hemangiomas in infants and children. Patients and methods: A prospective study was conducted between March 2011 and May 2015 on 43 patients with cutaneous hemangioma treated either with oral propranolol (group A, 23 cases) or with liquid nitrogen (cryotherapy) (group B, 20 cases). The outcome of treatment was evaluated clinically and with serial photographs before starting treatment and monthly thereafter as regards the size and color of the lesion. Propranolol was given orally 2 mg/kg per day in two divided doses for 4–6 months. Cryotherapy settings were applied two to four times for a period of 2–6 months under inhalation anesthesia using sevofl urane. Results: With propranolol, complete involution occurred in 78.2% of cases and good response in 17.3%. Regrowth of the lesion occurred after stopping propranolol in two cases; the parents of the children were instructed to continue the treatment for a further 3 months. With cryotherapy complete involution of the lesions occurred in 65% of cases. No recurrence was observed during the follow-up period. Hypopigmentation at the site of the treated area was evident in eight cases. Conclusion: Oral propranolol could be considered a safe and effective treatment strategy for cutaneous hemangioma. Although inhalational anesthesia is needed for application of cryotherapy, it is a simple method for treatment of cutaneous hemangioma and has minimal side effects. However, a randomized controlled study on a large number of patients should be conducted.