Successful experience of treatment of the infantile hemangioma of the critical localization zone with the local β-blockers

Abstract

Infantile hemangioma (IH) is the most common benign vascular tumor in infants and children under one year of age. 12% of children with IH have a tendency to develop dangerous complications, the development of which depends on the area of tumor localization, its size, growth rate, and the patient's age. Careful history taking and physical examination make it possible to verify IH located in critical localization zones (physiological openings, neck, palms and feet) where complications are most likely to develop and to choose the correct method of treatment in a timely manner. Difficulties may arise for the doctor when choosing between the appointment of local or systemic therapy with β-blockers when the IH is located in the critical localization zone.

Purpose - to present possibilities and successful experience of choosing between systemic and local treatment IH with β-blockers in the critical localization zone in a child.

Clinical case. 2-month-old boy’s parents came to the clinic with complaints about the appearance of a bright red neoplasm in the area of the upper lip in the child, which appeared 6 days after birth and had a tendency to active increase and infiltration of soft tissue. After examining, a clinical diagnosis was made: infantile hemangioma in the critical localization zone (in the area of the skin of the upper lip) in the proliferation phase. Ultrasound diagnosis of the tumor with a special skin sensor made it possible to establish the depth of infiltration. Taking into account the localization of the tumor next to the vital opening, the rapid growth of the tumor, the risk of breast-feeding disruption due to tumor infiltration of soft tissues and the child's age, a decision was made to refer the child for further examination to rule out contraindications to the appointment of systemic β-blockers. During the follow-up examination, local treatment with the β-blocker propranolol was prescribed. During the next two weeks of using local β-blockers, the growth of the hemangioma stopped, ultrasound recorded the cessation of deep proliferation. According to the obtained results, the doctor made a decision to continue treatment with local β-blockers without switching to systemic treatment. An 8-month course of treatment with local β-blockers made it possible to achieve complete stabilization and further regression of the tumor with an excellent cosmetic effect.

Conclusions. Infantile hemangiomas are dangerous tumors in children of the first year of life and require careful observation and timely treatment. The article presents a clinical case of a child with critical localization IH, who was prescribed systemic β-blockers according to treatment protocols. In this case, the treatment with local β-blockers made it possible to obtain an excellent therapeutic and cosmetic effect.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.