Jonathan A Perkins1, Brian S Chen2, Babette Saltzman3, Scott C Manning4, Sanjay R Parikh4. 1. Seattle Children's Hospital Research Institute, Seattle, Washington2Division of Pediatric Otolaryngology-Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, Washington3Department of Otolaryngology-Head and Neck Surgery, Uni. 2. Department of Otolaryngology-Head and Neck Surgery, Madigan Healthcare System, Tacoma, Washington. 3. Seattle Children's Hospital Research Institute, Seattle, Washington. 4. Division of Pediatric Otolaryngology-Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, Washington3Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle.
Abstract
IMPORTANCE: Propranolol therapy is changing the treatment paradigm for infantile hemangioma. This study addresses the effect of propranolol therapy on the treatment of nasal infantile hemangioma (NIH), an area that often does not respond to medical therapy. OBJECTIVE: To determine if propranolol treatment is associated with fewer invasive treatments for NIH. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study conducted within a single pediatric institution's multidisciplinary vascular anomaly program for patients with NIH treated between January 1, 2003, and December 31, 2011. Three NIH cohorts were compared: prepropranolol (20 in group 1; 2003-2009), propranolol (25 in group 2; 2009-2011), and nonpropranolol (13 in group 3; 2009-2011) treatment. INTERVENTIONS: Analysis of systemic medical, laser, or surgical therapies for NIH. MAIN OUTCOMES AND MEASURES: The study plan was created to detect a change in invasive therapy for NIH. Data collected included presenting age, sex, affected nasal subunits, infantile hemangioma morphologic characteristics, treatment type and number, and primary treating service. An NIH grading system, based on nasal subunit involvement, helped quantify treatment change. Descriptive statistics summarized data, and a Cox proportional hazards regression model evaluated propranolol use and the likelihood of invasive treatments (surgical excision or laser). RESULTS: Of the 95 patients identified, 58 met inclusion criteria: 20 in group 1 (mean age, 4.8 months), 25 in group 2 (mean age, 4.9 months), and 13 in group 3 (mean age, 4.9 months). Nasal infantile hemangiomas involved the nasal tip subunit in 33 of 58 patients (56.9%). Eight of 13 patients (61.5%) in group 3 frequently had small NIH (grade 1). Patients in group 2 were less likely to undergo any invasive treatments (relative risk, 0.44; 95% CI, 0.27-0.73), have surgical excision only (0.45; 0.15-1.38), or undergo laser treatment only (0.44; 0.27-0.78) compared with those in group 1. Patients with higher-grade NIH had more medical or invasive therapy, but invasive procedures were carried out in each subgroup defined by grade. CONCLUSIONS AND RELEVANCE: Patients with isolated propranolol-treated NIH were less likely to undergo invasive treatment, but despite its implementation, the need for invasive treatment was not totally supplanted by its use.
RCT Entities:
IMPORTANCE: Propranolol therapy is changing the treatment paradigm for infantile hemangioma. This study addresses the effect of propranolol therapy on the treatment of nasal infantile hemangioma (NIH), an area that often does not respond to medical therapy. OBJECTIVE: To determine if propranolol treatment is associated with fewer invasive treatments for NIH. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study conducted within a single pediatric institution's multidisciplinary vascular anomaly program for patients with NIH treated between January 1, 2003, and December 31, 2011. Three NIH cohorts were compared: prepropranolol (20 in group 1; 2003-2009), propranolol (25 in group 2; 2009-2011), and nonpropranolol (13 in group 3; 2009-2011) treatment. INTERVENTIONS: Analysis of systemic medical, laser, or surgical therapies for NIH. MAIN OUTCOMES AND MEASURES: The study plan was created to detect a change in invasive therapy for NIH. Data collected included presenting age, sex, affected nasal subunits, infantile hemangioma morphologic characteristics, treatment type and number, and primary treating service. An NIH grading system, based on nasal subunit involvement, helped quantify treatment change. Descriptive statistics summarized data, and a Cox proportional hazards regression model evaluated propranolol use and the likelihood of invasive treatments (surgical excision or laser). RESULTS: Of the 95 patients identified, 58 met inclusion criteria: 20 in group 1 (mean age, 4.8 months), 25 in group 2 (mean age, 4.9 months), and 13 in group 3 (mean age, 4.9 months). Nasal infantile hemangiomas involved the nasal tip subunit in 33 of 58 patients (56.9%). Eight of 13 patients (61.5%) in group 3 frequently had small NIH (grade 1). Patients in group 2 were less likely to undergo any invasive treatments (relative risk, 0.44; 95% CI, 0.27-0.73), have surgical excision only (0.45; 0.15-1.38), or undergo laser treatment only (0.44; 0.27-0.78) compared with those in group 1. Patients with higher-grade NIH had more medical or invasive therapy, but invasive procedures were carried out in each subgroup defined by grade. CONCLUSIONS AND RELEVANCE: Patients with isolated propranolol-treated NIH were less likely to undergo invasive treatment, but despite its implementation, the need for invasive treatment was not totally supplanted by its use.
Authors: Mariana Carvalho Costa; Odil Garrido Campos de Andrade; Lethícia de Castro Pereira; Izelda Maria Carvalho Costa Journal: An Bras Dermatol Date: 2020-01-21 Impact factor: 1.896