Shehata Nancy, Powell Julie, Dubois Josée, Hatami Afshin, Rousseau Elizabeth, Ondrejchak Sandra, McCuaig Catherine
Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Quebec, Canada.
Pediatr Dermatol. 2013 Sep-Oct;30(5):587-91. doi: 10.1111/pde.12190.
Propranolol has become the first line of treatment for infantile hemangiomas (IHs), with a high response rate, but rebound growth after cessation of propranolol has been reported, primarily in the first year of life. We sought to determine the frequency and associated factors leading to late regrowth after successful treatment at an age when the proliferative phase has usually ceased. We retrospectively reviewed the clinical charts, serial photographs, and radiologic images of children with rebound IH occurring after the age of 15 months after a successful course of oral propranolol averaging 2.6 mg/kg/day (range 2-3 mg/kg/day). Thirteen (10 female, 3 male) of 212 patients (6%) treated with oral propranolol since 2008 were evaluated. The mean age at the start of treatment was 5.3 months (range 1.8-13 months), and an average of 10.3 months (range 4.5-16 months) of treatment was given. It took an average of 5.3 months (range 1-13.8 months) for a significant rebound to appear. Late rebound after successful propranolol indicates a prolonged proliferation phase of IH even after 15 months of age. This is compared with previous reports of rebound, which occurred primarily in infants younger than 1 year old. Late proliferation can occur in localized, small, mixed, and deep IH, even after several months of a positive response to propranolol. A second course of propranolol readily controlled the recurrence.
普萘洛尔已成为婴儿血管瘤（IHs）的一线治疗药物，有效率高，但有报道称在停用普萘洛尔后会出现反弹生长，主要发生在生命的第一年。我们试图确定在增殖期通常已经停止的年龄成功治疗后导致后期再生长的频率及相关因素。我们回顾性分析了自2008年以来接受平均2.6mg/kg/天（范围2 - 3mg/kg/天）口服普萘洛尔成功治疗后15个月龄后出现IH反弹的儿童的临床病历、系列照片和影像学图像。对212例接受口服普萘洛尔治疗的患者中的13例（10例女性，3例男性）（6%）进行了评估。开始治疗时的平均年龄为5.3个月（范围1.8 - 13个月），平均接受了10.3个月（范围4.5 - 16个月）的治疗。显著反弹出现平均需要5.3个月（范围1 - 13.8个月）。普萘洛尔治疗成功后的后期反弹表明即使在15个月龄后IH的增殖期仍延长。这与之前主要发生在1岁以下婴儿的反弹报道不同。后期增殖可发生在局限性、小型、混合型和深部IH中，即使在对普萘洛尔有几个月的阳性反应之后。再次使用普萘洛尔疗程可轻易控制复发。
