Long-term outcomes of oral propranolol for facial infantile hemangioma

Background: Oral propranolol is the first-line treatment for problematic infantile hemangiomas (IHs) requiring systematic therapy. Several retrospective studies have reported the successful treatment of facial IHs with propranolol. In this study, we conducted a prospective trial to evaluate the long-term outcomes of oral propranolol use in patients with facial IHs. Methods: The primary outcome was the clinical response 4 years after treatment. Results: A total of 272 patients were analyzed, including 38 (14.0%) patients with ulcerated IHs. Four years after treatment, propranolol treatment had resulted in no/minimal sequelae in 232 patients (85.3%). A total of 265 (97.4%) patients reported a durable response to propranolol therapy. Major rebound occurred in 16.9% of patients after propranolol discontinuation. Additional surgery and laser treatment were required in 8.1% and 8.8% of patients, respectively. Logistic regression analyses revealed that age ≥ 3 months (95% confidence interval [CI], 1.488–31.023; P =0.013), nasal IH (95% CI, 2.143–97.571; P =0.006) and hemangioma ulceration (95% CI, 2.673–49.034; P =0.001) were independent factors predictive of long-term severe/significant sequelae. Segmental subtype (95% CI, 2.081–45.597; P =0.004), mixed IH (95% CI, 3.249–26.841; P <0.001) and lip IH (95% CI, 2.224–92.278; P =0.005) were independent risk factors for major rebound. Conclusions: In this large cohort of patients with facial IHs, propranolol treatment was effective and induced no/minimal sequelae at 4 years after treatment. However, long-term severe/significant sequelae and major rebound after propranolol treatment remain challenges.