One of the most exciting therapeutic discoveries of the past decade has been the use of propranolol for treatment of problematic infant hemangiomas. What we have recently begun to see, however, is a recurrence of the hemangioma when propranolol is stopped in anywhere from 20 to 25% of patients. So who is likely to develop rebound and what are some predictive risk factors that might increase the likelihood of this occurring? Shah et al. (10.1542/peds.2015-1754) share with us the results of their multicenter retrospective cohort study this week in close to 1000 patients with infantile hemangiomas treated with propranolol. While the authors report that 25% of their cohort experienced rebound consistent with prior reports, they also discovered a relationship between the duration of usage correlating positively with the odds of rebound occurring. In fact, those who stopped the drug before 9 months of age were more apt to show rebound than those who continued the drug past a year of age.
The authors do more than just skin the surface with this analysis and go on to identify the types of hemangiomas more susceptible to rebound, the location and even a gender predisposition for having this problem occur. If want more of the specifics regarding these variables contributing to rebound, I would encourage you to not just read this blog—but link to the article and learn more as well as how these patients with hemangioma rebound were subsequently treated.
To add further perspective on this study, pediatric dermatologist Dr. Anthony Mancini has written an accompanying commentary that makes its mark on the rebound phenomenon seen with these vascular birthmarks. Have you seen your patients experience rebound after stopping the propranolol when a hemangioma appeared adequately treated? Share with us your experience by responding to this blog, posting a comment online with the article, or by sharing your input on our Facebook or Twitter.
