Comparative Study of Effectiveness between Oral Propranolol and Combined Oral Propranolol with Prednisolone in the Treatment of Infantile Hemangioma

Background: The most prevalent benign vascular tumor found within pediatric patients is infantile hemangioma since its birth frequency stands at 2-3% that progressively surges to 10% by the first birthday. The therapeutic advantage of administering combined propranolol and corticosteroids compared to propranolol as a standalone treatment for Infantile hemangiomas remains an ambiguous matter. However, the efficacy of propranolol in treating IH patients is not universal. Systemic corticosteroids have known side effects such as water retention, hypertension and hyperglycemia, which could counter the adverse effects of propranolol like hypotension, bradycardia, hypoglycemia.

Objective: To compare the clinical outcomes and safety profile of oral propranolol monotherapy versus combined oral propranolol and prednisolone in the treatment of infantile hemangioma.

Methods: An observational study was conducted at BSMMU from October 2018 to August 2019, involving 62 patients with IH up to 4 years of age. Patients were divided into two groups: Group A (n=31) received oral propranolol alone, while Group B (n=31) received combined oral propranolol and prednisolone. Treatment outcomes were assessed using Visual Analogue Scale (VAS) for color changes and percentage of size regression.

Results: Both groups showed improvement in color clearance and size regression. In Group A, 22.6% showed excellent color clearance versus 6.5% in Group B. Mean size regression was 68.05% in Group A and 59.35% in Group B, though the difference was not statistically significant. However, Group B experienced significantly more adverse effects (61.3%) compared to Group A (25.8%) (p=0.005).

Conclusion: This research shows that propranolol treatment alone provides similar results as prednisolone combination treatment for infantile hemangioma but produces less adverse side effects. The regular care of infantile hemangioma does not require prednisolone administration with propranolol.