Recurrence of infantile hemangioma? Consider a second round of propranolol


Using oral propranolol to treat infantile hemangioma is a normal clinical course. When faced with a recurrence of the hemangioma, is a second course of propranolol warranted?

A second cycle of oral propranolol therapy (OPT), the treatment of choice for infantile hemangiomas (IHs), was associated with a successful outcome in a retrospective analysis of all IHs treated during a 6-year period at a center for pediatric surgery in Germany. Out of a total of 198 IH cases in children aged no older than 1 year, 35 patients (18%) experienced regrowth after OPT. Approximately three-quarters (77%) of the patients with regrowth had IHs on the face, which were associated with a significantly higher rate of regrowth than IHs located elsewhere. The median time between the end of therapy and regrowth was 1.5 months, regardless of where the IH was located.

Of the patients with IH growth relapse, 23 (18 facial and 5 in other locations) underwent a second cycle of OPT, with a median treatment length of 3 months. All 198 evaluated cases of IH were resolved successfully, either after a single cycle of OPT or, when regrowth occurred, after a second therapy cycle or further conservative management. Treatment was not associated with any severe adverse events, but about 10% of patients experienced minor problem, including vomiting or diarrhea, fatigue, or cold extremities.1

Thoughts from Dr. Farber

Propranolol has been a major breakthrough and can be started as an outpatient (with support from a specialist if you are uncomfortable) despite earlier recommendations not to do so. Don’t be afraid to begin a second course, in needed because of regrowth.


  1. Frongia G, Byeon JO, Mehrabi A, Günther P. Recurrence rate of infantile hemangioma after oral propranolol therapy. Eur J Pediatr. Epub ahead of print.2020;180(2):585-590. doi:10.1007/s00431-020-03872-5
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