Management of Head and Neck Hemangiomas in Adults: Oral Propranolol Versus Oral Itraconazole in Conjugation with Injection Sodium Tetra Decyl Sulphate

  • Siddharth PanditrayEmail author
  • Sauvagini Acharya
  • Nilamadhab Prusty
  • Subha Saumya Dany
Original Article


Management of head and neck hemangiomas with oral propranolol versus oral itraconazole in conjugation with injection sodium tetra decyl sulphate. This prospective parallel clinical trial was done to check for the effectiveness of oral propranolol and oral itraconazole when used in conjugation with inj. sodium tetra decyl sulphate in treatment of head and neck haemangiomas in adult patients visiting department of ENT and head and neck surgery, VIMSAR, Burla. All the patients visiting the department with hemangioma (diagnosed clinically and by FNAC) were considered and only those who gave written informed consent and were according to our inclusion and exclusion criteria were included into the study as subjects. Dimension (length, width and hemi-circumference) of the haemangiomas were measured using disposable paper taper measures. Depth of the hemangioma was calculated based on formula and using that volume was calculated both at baseline and after 8 weeks of drug administration. Data so collected was entered into Microsoft Office Excel 2013 and statistical analysis was performed using SPSS Version 20.0. Descriptive statistics was calculated and student’s t test (paired and unpaired) was used to compare within the group (before and after) and between the groups respectively. Statistical significance was set at p ≤ 0.05. Both the groups showed statistically significant volume reduction in the lesions [p < 0.018 (propranolo + sodium tetra decyl sulphate), p < 0.025 (itraconazole + sodium tetra decyl sulphate)]. The mean decrease in volume in propranolol group was 91.92% and that in itraconazole group was 88.97%. There was no statistical difference between the final outcome of both the groups (p < 0.766) but 3 patients on propranolol had complete resolution while 1 patient on itraconazole had complete resolution of the lesion. Oral propranolol and itraconazole are both effective and safe in hemangioma in adults. The combination with inj. sodium tetra decyl sulphate has a (1) favorable impact on decreasing the overall duration of treatment. (2) Aiding in complete resolution of lesions (especially < 3 cm). Propranolol has an edge over itraconazole (more no of tumors had complete resolution).


Hemangiomas Propranolol Itraconazole Sclerotherapy 


Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The study did not require any ethical approval of any kind.

Informed consent

The participants did not have to provide formal consent for the treatment.


  1. 1.
    Kilcline C, Frieden IJ (2008) Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol 25:168CrossRefGoogle Scholar
  2. 2.
    Blei F, Walter J, Orlow SJ, Marchuk DA (1998) Familial segregation of hemangiomas and vascular malformations as an autosomal dominant trait. Arch Dermatol 134:718CrossRefGoogle Scholar
  3. 3.
    Buckmiller LM, Richter GT, Suen JY (2010) Diagnosis and management of hemangiomas and vascular malformations of the head and neck. Oral Dis 16:405–418CrossRefGoogle Scholar
  4. 4.
    Berk DR, Berk EJ, Bruckner AL (2011) A novel method for calculating the volume of hemangiomas. Pediatr Dermatol 28(4):478–482CrossRefGoogle Scholar
  5. 5.
    Ho NT, Lansang P, Pope E (2007) Topical imiquimod in the treatment of infantile hemangiomas: a retrospective study. J Am Acad Dermatol 56:63–68CrossRefGoogle Scholar
  6. 6.
    Pope E, Krafchik BR, Macarthur C et al (2007) Oral versus highdose pulse corticosteroids for problematic infantile hemangiomas:a randomized, controlled trial. Pediatrics 119:e1239–e1247CrossRefGoogle Scholar
  7. 7.
    Sans V, Dumas de la Roque E, Berge J et al (2009) Propranolol for severe infantile hemangiomas: follow-up report. Pediatrics 124:423–431CrossRefGoogle Scholar
  8. 8.
    Annabi B, Lachambre MP, Plouffe K, Moumdjian R, Béliveau R (2009) Propranolol adrenergic blockade inhibits human brain endothelial cells tubulogenesis and matrix metalloproteinase-9 secretion. Pharmacol Res 60(5):438–445. CrossRefPubMedGoogle Scholar
  9. 9.
    Zhang D, Ma Q, Shen S et al (2009) Inhibition of pancreatic cancer cell proliferation by propranolol occurs through apoptosis induction. Pancreas 38:94–100CrossRefGoogle Scholar
  10. 10.
    Storch CH, Hoeger PH (2010) Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action. Br J Dermatol 163:269–274. CrossRefPubMedGoogle Scholar
  11. 11.
    Aletaha M, Salour H, Bagheri A, Raffati ND, Amouhashemi N (2012) Oral propranolol for treatment of pediatric capillary hemangiomas. J Ophthalmic Vis Res 7(2):130–133PubMedPubMedCentralGoogle Scholar
  12. 12.
    Gajbhiye V, Nath S, Chatterjee S, De A, Ghosh D, Das SK (2011) Role of propranolol in hemangiomas. J Indian Assoc Pediatr Surg 16(4):173–174CrossRefGoogle Scholar
  13. 13.
    Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A (2008) Propranolol for severe hemangiomas of infancy. N Engl J Med 358(24):2649–2651CrossRefGoogle Scholar
  14. 14.
    Fette A (2013) Propranolol in use for treatment of complex infant hemangiomas: literature review regarding current guidelines for pre assessment and standards of care before initiation of therapy. Sci World J 2013:850193. CrossRefGoogle Scholar
  15. 15.
    Painter SL et al (2016) Review of topical beta blockers as treatment for infantile hemangiomas. Surv Ophthalmol 61(1):51–58CrossRefGoogle Scholar
  16. 16.
    Ohnishi K, Tagami M, Morii E, Azumi A (2014) Topical treatment for orbital capillary hemangioma in an adult using a β-blocker solution. Case Rep Ophthalmol 5:60–65CrossRefGoogle Scholar
  17. 17.
    Murthy GJ, Goswami M (2012) Management of adult onset orbital hemangioma by oral propranolol: a case report. Orbit 31(5):373–375CrossRefGoogle Scholar
  18. 18.
    Khoury TR (2015) Adult hepatic hemangioma: an updated review with focus on the natural course and treatment options. Abdomen 2:e908. CrossRefGoogle Scholar
  19. 19.
    Mazereeuw-Hautier J, Hoeger PH, Benlahrech S, Ammour A, Broue P, Vial J et al (2010) Efficacy of propranolol in hepatic infantile hemangiomas with diffuse neonatal hemangiomatosis. J Pediatr 157:340–342CrossRefGoogle Scholar
  20. 20.
    Bertrand J, McCuaig C, Dubois J, Hatami A, Ondrejchak S, Powell J (2011) Propranolol versus prednisone in the treatment of infantile hemangiomas: a retrospective comparative study. Pediatr Dermatol 28:649–654. CrossRefPubMedGoogle Scholar
  21. 21.
    Abarzúa-Araya A, Navarrete-Dechent CP, Heusser F, Retamal J, Zegpi-Trueba MS (2014) Atenolol versus propranolol for the treatment of infantile hemangiomas: a randomized controlled study. Am Acad Dermatol 70(6):1045–1049CrossRefGoogle Scholar
  22. 22.
    Ezekowitz RA, Mulliken JB, Folkman J (1992) Interferon α2a therapy for the life—threatening haemangioma ofinfancy. N Engl J Med 326(22):1456–1463CrossRefGoogle Scholar
  23. 23.
    Bauman NM, Burke DK, Smith RH (1997) Treatment of massive or life-threatening hemangiomas with recombinant α2a-interferon. Otolaryngol Head Neck Surg 117(1):99–110CrossRefGoogle Scholar
  24. 24.
    Perez J, Pardo J, Gomez C (2002) Vincristine—an effective treatment of corticoid-resistant life-threatening infantile hemangiomas. Acta Oncol 41(2):197–199CrossRefGoogle Scholar
  25. 25.
    Pope E, Krafchik BR, Macarthur C et al (2007) Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial. Pediatrics 119(6):e1239–e1247CrossRefGoogle Scholar
  26. 26.
    Grant SM et al (1989) Itraconazole. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial and systemic mycoses. Drugs 37(3):310–344CrossRefGoogle Scholar
  27. 27.
    Head SA, Shi W, Zhao L, Gorshkov K, Pasunooti K, Chen Y, Deng Z, Li RJ, Shim JS, Tan W, Hartung T (2015) Antifungal drug itraconazole targets VDAC1 to modulate the AMPK/mTOR signaling axis in endothelial cells. Proc Natl Acad Sci 112(52):E7276–E7285. CrossRefPubMedGoogle Scholar
  28. 28.
    Kim J, Tang JY, Gong R, Kim J, Lee JJ, Clemons KV, Chong CR, Chang KS, Fereshteh M, Gardner D, Reya T, Liu JO, Epstein EH, Stevens DA, Beachy PA (2010) Itraconazole, a commonly used anti-fungal that inhibits Hedgehog pathway activity and cancer growth. Cancer Cell 17(4):388–399. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Dang Y, Ren YR, Liu JO (2010) Cholesterol trafficking is required for mTOR activation in endothelial cells. Proc Natl Acad Sci 107(10):4764–4769. CrossRefPubMedGoogle Scholar
  30. 30.
    Nacev BA et al (2011) The antifungal drug itraconazole inhibits vascular endothelial growth factor receptor 2 (VEGFR2) glycosylation, trafficking, and signaling in endothelial cells. J Biol Chem 286(51):44045–44056CrossRefGoogle Scholar
  31. 31.
    Goktas S et al (2014) Antiangiogenic effect of itraconazole on corneal neovascularization: a pilot experimental investigation. Ophthalmic Res 52(4):170–174CrossRefGoogle Scholar
  32. 32.
    Ran Y, Chen S, Dai Y, Kang D, Lama J, Ran X, Zhuang K (2015) Successful treatment of oral itraconazole for infantile hemangiomas: a case series. J Dermatology 42(2):202–206. CrossRefGoogle Scholar
  33. 33.
    Agarwal S (2012) Treatment of oral hemangioma with 3% sodium tetradecyl sulfate: study of 20 cases. Indian J Otolaryngol Head Neck Surg 64(3):205–207. CrossRefPubMedGoogle Scholar
  34. 34.
    Choi B-E, Kim Y, Leem D-H, Baek J-A, Ko SO (2016) Utility of sodium tetradecyl sulfate sclerotherapy from benign oral vascular lesion. Maxillofac Plast Reconstr Surg 38(1):44. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Reddy GSP, Reddy GV, Reddy KSK, Priyadarshini BS, Sree PK (2016) Intralesional sclerotherapy: a novel approach for the treatment of intraoral haemangiomas. J Clin Diagn Res JCDR 10(1):ZD13–ZD14. CrossRefPubMedGoogle Scholar
  36. 36.
    Grover C, Khurana A, Bhattacharya SN (2012) Sclerotherapy for the treatment of infantile hemangiomas. J Cutan Aesthet Surg 5(3):201–203. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Grover C, Arora P, Kedar A, Pal P, Lal B (2010) Combination of oral corticosteroids and polidocanol sclerotherapy in the management of infantile hemangiomas. Dermatol Surg 36(12):2030–2036. CrossRefPubMedGoogle Scholar
  38. 38.
    Ma X, Chang M, Ouyang T et al (2015) Combination of propranolol and sclerotherapy for treatment of infantile parotid hemangiomas. Int J Clin Exp Med 8(7):10865–10874PubMedPubMedCentralGoogle Scholar
  39. 39.
  40. 40.

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Department of ENT and Head Neck SurgeryVSSIMSARBurlaIndia
  2. 2.Department of Dental SurgeryVIMSARBurlaIndia

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