Higher Doses of Oral Propranolol for Resistant Infantile Haemangiomas

Propranolol at 3 mg/kg/day is considered the gold standard for treating infantile haemangiomas. Nevertheless, the management of propranolol-resistant infantile haemangiomas (PRIH) remains challenging. This national multicentre retrospective observational study includes all PRIHs who received propranolol > 3 mg/kg/day. The study aims to investigate the pattern of PRIHs, assess the effects and tolerance of a higher dose, and identify predictive factors for response to this increased dosage. Fifteen PRIHs were included (prevalence 0.45%), mainly females, and most presented with a large lesion. Three distinct patterns of PRIH were identified: facial segmental lesions (47%), facial localized lesions with a subcutaneous component (40%), and body-localized mixed and ulcerated lesions (13%). Six PRIH (40%) responded to the higher dose (from 3.75 to 4 mg/kg/day). Three predictive factors were significantly associated with a good response: IGIc-IH1 at the end of 3 mg/kg/day regimen (OR = 22.9, 95% CI 1.2–1844.1), a duration of 3.5 months or more at 3 mg/kg/day (OR = 17.5, 95% CI 1.22–250.37), and 7 months or more at > 3 mg/kg/day (OR = 17.5, 95% CI 1.22–250.37). Tolerance was generally good, although one patient experienced severe hypotension during dose escalation. Propranolol doses higher than 3 mg/kg/day may therefore be considered a potential treatment option for PRIHs.