A haemangioma is a collection of small immature blood vessels. They
are sometimes called ‘strawberry marks’ because the surface of some
haemangiomas look a bit like a strawberry.Propanolol
Haemangiomas can be superficial or deep in the skin. Some
haemangiomas are a combination of the two, seen as a raised red area on
the surface of the skin, and as a bluish swelling of abnormal blood
vessels deeper in the skin. Very occasionally haemangiomas may occur
Haemangiomas are not usually obvious at birth but become apparent within
a few days or weeks. They grow rapidly in the first three months,
increasing in size and sometimes in redness.It is unusual for
haemangiomas to grow after six to 10 months of age, when most
haemangiomas tend to have a ‘rest period’ and then begin to shrink.
What is propranolol?
Propranolol is a beta-blocker. Some nerves release a chemical called
noradrenaline when they are stimulated, which in turn stimulates ‘beta
adrenergic receptors’. These can cause a variety of effects. For
instance, if the beta adrenergic receptors in the heart are stimulated,
the heart pumps harder and faster than before, so more blood is pumped
around the body. Betablocker medicines block the beta adrenergic
receptors and stop them being stimulated.
How does propranolol help with haemangiomas?
By blocking the beta adrenergic receptors, propranolol can make blood
vessels narrower, reducing the amount of blood flowing through them.
This is particularly effective in haemangiomas, by reducing the colour
and making them softer. Growth of the haemangioma cells is also limited
by propranolol so that the haemangioma starts to reduce in size. More
research is needed to fully understand how propranolol works. The
beneficial effects are usually seen very quickly.
Are there side effects with propranolol treatment?
Propranolol is associated with the following side effects, which happen
very rarely. However, you should report any of the following to your
doctor as the dose of propranolol may need to be altered or on very rare
Bradycardia (slow heart rate).
Hypotension (low blood pressure).
Bronchspasm (temporary narrowing of the airway, leading to wheezing and coughing).
Peripheral vasoconstriction (reduced blood flow to the extremities, such
as fingers and toes, making them feel cold and turn a blue colour).
Weakness and fatigue, showing as floppiness and disinterest in surroundings.
Hypoglycaemia (low blood sugar).
Gastrointestinal disturbances such as constipation or diarrhoea.
If you have any concerns about these side effects, please discuss them with your doctor, nurse or pharmacist.
Are any tests needed before starting propranolol treatment?
Occasionally we will suggest some tests to check that your child can
safely take the medicine. These may include blood and urine tests, an
electrocardiogram (ECG) and echocardiogram (echo). If your child has
multiple haemangiomas visible on the skin, we may also carry out an
abdominal ultrasound scan to look for any haemangiomas in the liver.
What happens when my child starts treatment?
Some infants will be monitored for two hours after the first dose. This
monitoring allows the doctors to be absolutely sure your child can
tolerate the prescribed dose. The procedure is occasionally repeated
after one week when the dose is increased, although the dose is normally
increased at home.