Propranolol-induced Involution of Infantile Hemangioma

A 4-week-old girl with infantile (capillary) hemangioma involving the periocular area (A) underwent a 12-month course of oral propranolol, leading to significant involution (B). The residual lesion, unresponsive to propranolol, was excised to treat anisometropic amblyopia. Histopathologic evaluation revealed lobules of capillary-sized vascular channels lined by flattened endothelium that expressed glucose transporter-1 (GLUT1), compatible with infantile hemangioma (arrow), adjacent to non-lesional GLUT1-negative vessels (arrowheads) (C, original magnification ×100). Endothelial cell apoptotic debris (arrows; D, original magnification ×400) and focally hyalinized vascular channels with concentric Periodic acid-Schiff-positive material (arrowheads) are classic histologic findings seen in β-blocker-induced involution of infantile hemangioma (Magnified version of Figure A-D is available online at www.aaojournal.org).