Following the work of Léauté-Labrèze et al. in 2008, describing the successful use of beta blockers in the treatment of infantile haemangiomas, the medical treatment of these troublesome malformations has almost completely replaced surgical treatment, which has been relegated to a minor ‘tidy up’ role, in a few cases. Nevertheless, some serious side-effects following the use of propanolol  (a lipophylic, non selective beta blocker), such as hypoglycaemia, bronchial hyper reactivity, hyperkalaemia and diarrhoea have been reported. In this study, atenolol (a hydrophilic, selective beta-1blocker) achieved similar good results to propanolol. As far as side-effects go, in the 30 patients treated with atenolol, there was one episode of hypoglycaemia and bronchial hyperactivity, compared with 25% in those 28 cases treated with propanolol. Mild side-effects, such as restless sleep, constipation and diarrhoea occurred in 40% of cases treated with atenolol compared with 50% in the propanolol group. So, atenolol (starting dose 0.5mg/Kg daily for one week, doubling this dose in the second week and, if this was insufficient, increasing the dose to a maximum of 3mg/Kg/day) would appear to be the better treatment for this condition. Physicians 10…Surgeons 1. 

Treatment of infantile haemangiomas with atenolol: comparison with a historical propranolol group.
de Graaf M, Raphael MF, Breugem CC, et al.
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