Journal of Cutaneous and Aesthetic Surgery
Print this page
Email this page
Small font size
Default font size
Increase font size
Home About us Current issue Archives Instructions Submission Subscribe Editorial Board Partners Contact e-Alerts Login 


 
   Table of Contents     
CORRESPONDENCE  
Year : 2014  |  Volume : 7  |  Issue : 2  |  Page : 138-139
Author's reply


1 Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
2 Senior Resident, Department of Oral & Maxillofacial Surgery, Trauma Center, BHU, Varanasi, Uttar Pradesh, India

Click here for correspondence address and email

Date of Web Publication7-Aug-2014
 

How to cite this article:
Pandey V, Gangopadhyay A N, Tiwari P, Gupta D K, Sharma S P, Kumar V. Author's reply. J Cutan Aesthet Surg 2014;7:138-9

How to cite this URL:
Pandey V, Gangopadhyay A N, Tiwari P, Gupta D K, Sharma S P, Kumar V. Author's reply. J Cutan Aesthet Surg [serial online] 2014 [cited 2019 Apr 18];7:138-9. Available from: http://www.jcasonline.com/text.asp?2014/7/2/138/138373


Dear Editor,

We are thankful for the esteemed attention to our work. Herein, we have responded to the queries:

The down regulation of angiogenic growth factors like vascular endothelial growth factor (VEGF-A) by beta blockers has been proposed as the main mechanism of action in infantile haemangioma. [1] Picard et al., have shown that VEGF expression is uniformly increased in congenital haemangiomas (both involuting and non-involuting) compared to proliferating or involuting phase infantile haemangioma. [2] This prompted us for the use of propranolol in non-involuting congenital haemangioma (NICH). We observed response to NICH in our series, but we agree that larger prospective studies are required to further evaluate the efficacy of propranolol in NICH.

We have mentioned that superficial and progressive lesions responded faster compared to the lesions with large deeper component and in non-proliferative phase. All 3 patients (100%) who were non-responders and 8 (53.3%) patients with partial response had bulky deeper component.

We have cautiously used propranolol in children considering its potential life-threatening adverse effects. As part of ongoing study in our department, we have used propranolol in 84 children so far. We have not observed serious adverse effects in any child. Three children with adverse effects mentioned in the paper and 4 more children (ongoing study) who had adverse effects were thoroughly evaluated. Hyperkalaemia was not documented in any one of them. Though we agree that hyperkalaemia is one of the potential severe adverse effects, one should be very vigilant in this regard.

Propranolol is a valuable therapeutic alternative for treatment of ulcerated haemangioma. We have used antibiotics according to sensitivity in cases with proven infection on the basis of positive culture from the wound. The remaining cases were solely managed with propranolol.

Finally, we had proposed the title of article as, "Propranolol for Infantile and Non-Involuted Congenital Haemangiomas: Early Experience from a Tertiary Centre". This was modified according to the Journal's requirement by the Editorial board.

 
   References Top

1.Greenberger S, Bischoff J. Infantile hemangioma-mechanism(s) of drug action on a vascular tumor. Cold Spring Harb Perspect Med 2011:a006460.  Back to cited text no. 1
    
2.Picard A, Boscolo E, Khan ZA, Bartch TC, Mulliken JB, Vazquez MP, Bischoff J. IGF-2 and FLT-1/VEGF-R1 mRNA levels reveal distinctions and similarities between congenital and common infantile hemangioma. Pediatr Res 2008;63:263-7.  Back to cited text no. 2
    

Top
Correspondence Address:
Vaibhav Pandey
Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 25136224

Rights and PermissionsRights and Permissions




 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed748    
    Printed9    
    Emailed0    
    PDF Downloaded60    
    Comments [Add]    

Recommend this journal