Treatment of infantile hemangiomas before and
after the introduction of propranolol: a retrospective study
Jes Christian Rødgaard
Jesper Vandborg Bjerre
Tine Engberg Damsgaard
Received: 7 October 2013 /Accepted: 10 December 2013 / Published online: 28 December 2013
Springer-Verlag Berlin Heidelberg 2013
Background Propranolol was introduced as systemic pharma-
cotherapy for problematic hemangiomas in 2008 and is now
considered superior to corticosteroid. Other available treat-
ment modalities include surgery and laser therapy. In
November 2008, the first patient was treated with propranolol
at The Center for Vascular Anomalies, Aarhus University
Hospital. The aim of this study was to compare the treatment
modalities applied before and after the actual date.
Methods The present study was a retrospective study of pa-
tients treated for hemangioma between 1995 and 2012 at the
University Hospital of Aarhus, Denmark. Outcome measures
of interest included age at referral, the extent of evaluation by
different specialties, and the treatments administered.
Results One hundred twenty-one patients were included in the
study. The patients were divided into two groups, patients
treated before (study period 1) and after (study period 2)
November 2008, respectively. In study period 2, patients were
referred earlier for evaluation (0.82 versus 1.91 years, p=0.011).
Fewer patients were seen by plastic surgeons in study period 2
(63.9 versus 98.8 %, p<0.001), with more patients being re-
ferred for systemic treatment (12.9 versus 86.1 %, p<0.001). No
difference in the number of patients evaluated by dermatologists
was detected (p=0.417). In study period 2, fewer patients were
treated with surgery (38.9 versus 92.2, p<0.001) and laser
therapy (13.9 versus 42.4, p=0.003). After November 2008,
more patients have been treated with systemic pharmacotherapy
(4.7 versus 80.6 %, p<0.001).
Conclusion The introduction of propranolol has resulted in a
decline in surgery and laser therapy at our institution. More
patients are being referred for systemic pharmacotherapy due
to the treatment protocol of propranolol.
Level of Evidence: Level IV, therapeutic study.
Keywords Vascular tumour
According to the ISSVA Classification, vascular anomalies of
infancy and childhood may be divided into two major cate-
gories, vascular tumours and vascular malformations. The
present study focuses on hemangioma, which is the most
common paediatric vascular tumour, mainly occurring a few
weeks after birth. The tumours are found in about 5 % of all
infants , typically located to the head and neck.
Within the first year of life, the tumours grow progressively
to reach their maximum size. This proliferative phase is
followed by an involution stage in which the tumours slowly
regress, usually proceeding for several years. After complete
regression, a residual fibrofatty mass often persists (involuted
phase). Characteristics significantly associated with hemangi-
omas include female gender, preterm birth, preeclampsia,
placenta previa, low gestational weight, white non-Hispanic
race and increasing maternal age .
In the majority of cases, hemangiomas do not require any
treatment as they spontaneously regress over the years.
However, in some patients, early intervention may be indicat-
ed in the proliferative phase. Hemangiomas with segmental
distribution, periorbital, perioral, anogenital or nasal tip
J. C. Rødgaard (*)
T. E. Damsgaard
Department of Plastic Surgery and Reconstruction, Aarhus
University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
Department of Plastic Surgery and Reconstruction, Odense
University Hospital, Odense, Denmark
J. V. Bjerre
Department of Pediatrics, Aarhus University Hospital, Aarhus,
Eur J Plast Surg (2014) 37:195–200