Management of Infantile Hemangiomas

Infantile haemangiomas are common benign vascular tumours of infancy that typically exhibit a rapid proliferative phase during the first months of life, followed by a gradual involution over several years. Management is guided by lesion size, location and risk of complications such as ulceration, visual impairment or airway obstruction. Oral propranolol has become the first-line systemic therapy owing to its efficacy in accelerating involution and reducing lesion volume. Topical β-blockers and corticosteroids remain valuable for superficial or smaller lesions, while intralesional agents and laser therapies are reserved for focal complications or incomplete response. Emerging approaches target metabolic and signalling pathways implicated in endothelial proliferation, offering potential adjuncts or alternatives to β-blockers. Close monitoring by clinical assessment and imaging ensures optimisation of treatment duration, mitigation of adverse effects and timely intervention for residual fibrofatty tissue or functional sequelae.

Research from Nature Portfolio

Analyses of a multi-centre cohort have characterised the incidence and predictors of intolerable side-effects during systemic propranolol therapy, revealing that younger infants and those with lower body weight face higher risk of bronchial reactivity and sleep disturbance. Transition to selective β-blockers or short-course corticosteroids proved effective and safe in cases of propranolol intolerance. Additional work has examined the optimal timing for discontinuing propranolol, demonstrating that tailoring treatment cessation to individual regression rates—assessed by ultrasound—reduces recurrence risk and limits unnecessary exposure to systemic therapy.

Management of Infantile Hemangiomas publication trend

The graph below shows the total number of articles in management of infantile hemangiomas across all publications each year (not limited to Nature Index journals).

Technical terms

Infantile haemangioma: A benign vascular tumour of infancy characterised by endothelial cell proliferation followed by spontaneous regression.

Propranolol: A non-selective β-adrenergic antagonist used systemically to induce accelerated involution of haemangiomas.

Angiogenesis: The formation of new blood vessels from existing vasculature, a key process in haemangioma proliferation.

Involution: The natural regression phase of a haemangioma during which vascular channels remodel and are replaced by fibrofatty tissue.

PFKFB3: A glycolytic regulatory enzyme whose inhibition reduces energy supply and angiogenic activity in haemangioma endothelial cells.

References

1. Infantile hemangioma: the common and enigmatic vascular tumor. Journal of Clinical Investigation (2024).
2. Intolerable side effects during propranolol therapy for infantile hemangioma: frequency, risk factors and management. Scientific Reports (2018).
3. When to stop propranolol for infantile hemangioma. Scientific Reports (2017).
4. Blockage of glycolysis by targeting PFKFB3 suppresses the development of infantile hemangioma. Journal of Translational Medicine (2023).
5. Evaluation of Five Ready-to-Use Bases for the Topical Administration of Propranolol Hydrochloride to Treat Infantile Hemangioma. Pharmaceutics (2025).