Abstract

Ulcerated infantile hemangiomas (IHs) represent a clinical challenge associated with significant morbidity, necessitating effective therapeutic interventions. This study aimed to systematically evaluate the effectiveness and safety of various treatments for ulcerated IHs. A systematic review adhering to preferred reporting items for systematic reviews guidelines was conducted by searching PubMed and Cochrane databases for studies published between 2011 and 2023, on interventions for ulcerated IHs. A total of 289 articles were initially identified from the systematic search, of which seven studies met the inclusion criteria for this review. The included studies highlighted the effectiveness of pharmacological and combination therapies. Oral propranolol resulted in ulcer healing in an average of 17.93 days, with 28.5% of patients achieving a complete response. Patients on nadolol had achieved 75% of shrinkage of IHS and faster than propranolol by 59%. Atenolol emerged as a potential alternative, shown to stop hemangioma growth in 93.4% of patients within 4 weeks. A combination of laser therapy and propranolol yielded a short-term curative effect of 98% compared to 82% in the control group receiving only laser therapy. A higher cure rate of 70% with the combination of surgical resection and pingyangmycin injection compared to 49% for each intervention alone. Recent pharmacological advancements, including propranolol, nadolol, and atenolol, offer promising results for managing ulcerated hemangiomas. Propranolol remains effective for regression, while nadolol provides a predictable pharmacological profile. Atenolol offers the convenience of once-daily dosing with fewer central nervous system-related adverse effects. Combination therapies, such as laser with propranolol, enhance short-term outcomes, underscoring the potential of multimodal approaches.

Key words: Infantile hemangioma, ulceration, treatment, efficacy, systematic review