THE USE of beta-blockers has dramatically changed the management of infantile hemangiomas, with a significant increase in active treatment decisions at tertiary referral centers, according to a new retrospective cohort study. The findings suggest a move away from the long-standing “watch and wait” approach traditionally employed for these common vascular tumors.
Researchers analyzed the clinical management of 1,701 patients with infantile hemangiomas in the modern beta-blocker era. Using the Hemangioma Severity Scale (HSS) and the risk stratification outlined by the American Academy of Pediatrics Clinical Practice Guidelines (AAP CPG), the team found that 68% of patients received active intervention. This is nearly double the 38% treatment rate reported in a comparable cohort from 2002 to 2003, before beta-blockers were widely adopted in clinical practice.
Patients who were treated had a median HSS of 9, indicating moderate to severe hemangiomas. Moreover, being classified as intermediate or high risk by the AAP guidelines was strongly associated with the decision to initiate therapy. These findings support a more proactive approach, particularly in higher-risk cases where the benefits of intervention outweigh potential risks.
Despite its retrospective design and setting in specialized centers, the study offers compelling evidence of a paradigm shift. Beta-blockers such as propranolol, nadolol, and timolol are now routinely employed to manage infantile hemangiomas, signaling a new standard in pediatric dermatologic care.
This evolution in treatment philosophy reflects growing confidence in the safety and efficacy of pharmacologic intervention. It also underscores the importance of risk-based stratification in determining the optimal course of care for infants with hemangiomas, many of whom may now avoid complications through earlier and targeted treatment.
Reference:
Faith EF et al. Paradigm shift in the management of infantile hemangiomas in the beta-blocker era: A retrospective cohort study. J Am Acad Dermatol. 2025:S0190-9622(25)02470-3.
