Compva: Infantile hemangioma face with rebound during propranolol therapy

Image 1 of 6

Only a few days after birth an increasing, red, slightly raised skin lesion has formed on the right side in the V-2 area. It is a segmental infantile hemangioma (IH) involving the lower eyelid on the right side.

Explanations

Infantile hemangioma

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Image 2 of 6

One month later, slightly increasing extension. Small nodular portions are beginning to form.

Explanations

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Image 3 of 6

During oral propranolol therapy there is a rapid regression of the IH. After discontinuation on 12.05., however, the findings rapidly recur with an increase in color intensity and area increase.

Recur with an increase in color intensity

Explanations

Rebound

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Image 4 of 6

After re-initiation of propranolol again on 06.06. initially good success. Discontinued again on 06.09. The regression remains incomplete, a few, rather patchy parts even increase in size again.

Regression remains incomplete, a few, rather patchy parts even increase

Explanations

Patchy regrowth

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Image 5 of 6

Without renewed use of propranolol because of the area involved now being small, lack of involvement of the eye and lack of risk of ulceration, there is now good regression of the findings in the 26th month of life. Centrally typical teleangiectasias appear frequently and mostly appear transiently on the skin during the course of regression.

Explanations

Teleangiectasia

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Image 6 of 6

At 40 months of age, the infantile hemangioma has regressed even further, including the teleangiectasias. These are now still visible in the nasal portion.

Explanations

Teleangiectasia

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Summary

Oral therapy with the beta blocker propranolol has revolutionized the conservative medical treatment of infantile hemangioma (IH).
Even findings at critical anatomical sites, such as the eye (lower eyelid with absent intraorbital involvement in the case presented here), can often be successfully treated with propranolol, provided therapy is initiated early enough.
The generally recommended duration of therapy is at least 6 months. Even with this length of therapy, but more often with shorter therapy, the lesion may regrow in some cases after discontinuation of the medication (so-called "rebound phenomenon").
This may necessitate re-initiation of therapy, as in the case presented here. Nevertheless, the prognosis remains good.