Caelan Donovan, before treatment with propranolol.
About 10 days after Caelan Donovan was born, her mom and dad started seeing swollen, strawberry-like marks on her face, particularly beneath her nose and near her left eye. Then they grew, rapidly. “It literally looked like she’d been punched in the face,” says her father, John Donovan.
Caelan’s pediatrician immediately referred the family to Hopkins Children’s dermatologist Bernard Cohen, who identified the lesions as hemangiomas, an abnormal collection of blood vessels in or beneath the skin that afflict up to 10 percent of newborns. They can be unsightly and disfiguring, Cohen explains, but typically after a few months they begin to regress on their own. For the more severe hemangiomas that threaten bodily functions like breathing and hearing, the standard treatment is steroids, though they are associated with serious side-effects like elevated blood sugars and reduced resistance to infection. Cohen prefers not to use steroids but here he had to.
“She had this very large lesion involving some important structures, including her vision and airway,” says Cohen.
Over the next month Caelan’s parents began to see some slight changes in the lesions, but they were concerned about the potential side effects of the steroids. Then Cohen informed them that he and fellow pediatric dermatologist Katherine Puttgen, spurred by a French study, were beginning to use the hypertension drug propranolol to help shrink hemangiomas. In using the beta-blocker to treat infants with heart problems who also happened to have hemangiomas, French doctors were surprised to discover their young patients’ hemangiomas swiftly began to fade. As propranolol’s side effects, including hypotension and hypoglycemia, are typically few and short-lived, the drug appeared to be a safe alternative. Also, in developing a protocol for their patients, Cohen and Puttgen worked with cardiologists and hospitalized the infants for the first two days of treatment to monitor for possible side effects. So far they have seen none, while results have been dramatic.
“Within a day or two we saw some big improvements in the hemangiomas growth,” says Karen Donovan, Caelan's mom. “They really started regressing.”
“The hemangiomas are just a fraction of their initial size, and the complication with the eye has completely resolved,” says Cohen.
Puttgen says the effect of propranolol on hemangiomas is not entirely clear, but a vascular growth factor may be down-regulated, speeding up cell death. Within 48 hours, she explains, the hemangiomas become softer and more compressible. Cautiously optimistic while awaiting formal clinical trials, Puttgen adds that propranolol may also mean a new treatment for disfiguring hemangiomas that often are allowed to run their course because they do not threaten bodily functions: “Now we feel that we have a reasonable alternative to address these really disfiguring lesions that are not necessarily function threatening.”
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