Patient Education

If you left your dermatologist’s office with a prescription for propranolol (pro-pran-no-lol), you can take comfort in knowing that your baby is getting a trustworthy treatment for a fast-growing birthmark.

Why would a dermatologist prescribe heart medication to treat a birthmark?

Yes, propranolol is a heart medicine. Today, it can also be a dermatologist’s go-to treatment for a type of birthmark called a hemangioma (he-man-gee-oh-ma).

This birthmark tends to grow quickly. If a hemangioma appears near your child’s eye, it could quickly cover the eye. This could cause a serious eye problem. Near the mouth, this birthmark can grow over the lips, making make it difficult for your baby to eat or breathe.

If the hemangioma grows over this baby’s eye, a serious health problem could develop.

When this birthmark could cause a serious health problem, it’s called a high-risk hemangioma.

The U.S. Food and Drug Administration (FDA) has approved propranolol to treat babies who have a high-risk hemangioma.

Studies show that propranolol can effectively:

• Prevent a hemangioma from growing
• Shrink a growing hemangioma

Why is this drug prescribed at such a young age?

You want to treat your child when the birthmark starts to grow. This helps prevent a serious health problem.

Since this birthmark starts to grow early in life, treatment often begins before a child is 6 months old.

How effective is propranolol at treating a strawberry (or deep) hemangioma?

Propranolol can work quickly. Within 24 hours of giving your child the first dose, the birthmark may feel softer. Soon after, you may see the birthmark start to shrink.

In studies, propranolol has proven to be more effective than the treatments previously used to treat these birthmarks. Propranolol also has fewer possible serious side effects than the other treatments.

A study published in the New England Journal of Medicine found that 60% of the children who received propanol were successfully treated within 24 weeks. This meant that the birthmark had completely disappeared or was almost gone.

Previous treatments haven’t worked this well.

Propranolol is the first and only FDA-approved treatment for this birthmark.

How long can a baby take propranolol?

While you may see the birthmark shrink quickly, it takes time to get the full benefit of this medicine.

You may need to give your child propranolol for 6 months or longer. This helps prevent the birthmark from returning.

Will propranolol lower my baby’s blood pressure?

When propranolol is used to treat a birthmark, doctors prescribe a type of this medication made just for babies. It may lower blood pressure, but this happens less often.

If there is a drop in a baby’s blood pressure, the drop tends to be temporary. Within 4 to 8 hours of getting this medicine, a baby’s blood pressure usually returns to normal.

What other possible side effects could my baby experience?

Researchers have found that the propranolol used to treat babies is safe and effective for most infants.

Like all medications, propranolol has possible side effects. To help prevent possible side effects, your dermatologist will examine your baby carefully before prescribing this medicine. Your baby may also need some tests before your dermatologist writes the prescription.

Your child’s dermatologist will also carefully monitor your child for side effects.

In studies, the most-common side effects in babies have been:

• Diarrhea
• Problem sleeping
• Cold hands and feet

More serious side effects can occur. These include low blood pressure (doesn’t go away within a few hours), low blood sugar, and a slow heart rate.

You can avoid low blood sugar by feeding your baby before (within 30 minutes) giving your child propranolol.

Another possible side effect is rebound. This means that the birthmark can return after you treat it. Gradually lowering the dose before stopping the medicine may prevent this. Giving your child the medicine for 6 months or longer can also prevent rebound.

How was it discovered that propranolol could treat a hemangioma?

This discovery came about by accident. No one gave a baby this medicine to see if it could treat a strawberry hemangioma.

This breakthrough began in France. A doctor gave a baby with serious heart condition this medicine. This baby also had a hemangioma.

The child’s pediatric dermatologist, Christine Léauté-Labrèze, MD, noticed that the birthmark (hemangioma) started to shrink almost immediately.

Because a strawberry hemangioma will eventually start to fade, it was possible that this birthmark had stopped growing at the same time the baby was given the propranolol.

Three months later, Dr. Léauté-Labrèze needed to treat a baby with a life-threatening hemangioma. The birthmark had already closed off one of the baby’s eyes and was making it difficult for the child to breath.

The usual treatment wasn’t working, and the baby began to have heart problems. To treat the heart problems, the baby was given propranolol.

Dr. Léauté-Labrèze noticed that the next day, the baby’s birthmark felt softer. Within a week, the baby could open his eye and the mass that was causing his breathing problems was smaller.

The baby stayed on the propranolol. By the time he was 6 months old, the only sign of the birthmark was some visible blood vessels.

It was then that the doctors knew that propranolol could effectively treat this birthmark.

Before the FDA approved it for treating birthmarks, scientists ran studies.

Images:
Image 1, Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Image 2, Getty Images

References
American Academy of Dermatology. “Interview with Christine Léauté-Labrèze, MD.” Dermatology World Meeting News. March 6, 2017.

Ji Y, Chen S, et al. “Safety and tolerance of propranolol in neonates with severe infantile hemangiomas: a prospective study.” Sci Rep. 2017 May 4;7(1):1503.

Léauté-Labrèze C, Hoeger P, et al. “A randomized, controlled trial of oral propranolol in infantile hemangioma.” N Engl J Med 2015;372:735-46.

McGee P, Miller S, et al. Propranolol for infantile haemangioma: A review of current dosing regime in a regional paediatric hospital. Ulster Med J 2013;82:16–20.

Moyakine AV, Spillekom-van Koulil S, et al. “Propranolol treatment of infantile hemangioma is not associated with psychological problems at 7 years of age.” J Am Acad Dermatol 2017;77:105-8.