European Journal of Pediatrics

, Volume 174, Issue 7, pp 855–865 | Cite as

Treatment of infantile haemangiomas: recommendations of a European expert group

  • Peter H. HoegerEmail author
  • John I. Harper
  • Eulalia Baselga
  • Damien Bonnet
  • Laurence M. Boon
  • Marta Ciofi Degli Atti
  • Maya El Hachem
  • Arnold P. Oranje
  • Agneta Troilius Rubin
  • Lisa Weibel
  • Christine Léauté-Labrèze


With a prevalence of 2.6–4.5 %, infantile haemangiomas (IH) represent the most common tumour of infancy. While the majority of IH does not require therapy and regresses spontaneously, about 10 % of IH exhibit complications such as obstruction, ulceration or disfigurement. With the advent of oral propranolol, many conventional treatment options have become obsolete. This paper summarizes current recommendations for management of complicated IH. These recommendations have been written by an expert group after a consensus process including bibliographic review, several drafts of synthesis, meetings with quantitative voting system and redaction of an approved final manuscript.

Conclusion: Oral propranolol is the first-line agent for the treatment of complicated IH.

What is Known:

Infantile haemangiomas (IH) are the most common tumours of infancy. Within a very short period after its discovery and long before the publication of randomized controlled trials, propranolol has become the number one agent for the treatment of complicated IH.

What is New:

We report IH treatment recommendations of an international, interdisciplinary team of experts, based on an up-to-date review of the literature.


Haemangioma Complications Therapy Infants 



European Medicines Agency


Endothelial progenitor cells


Food and Drug Administration (USA)


Glucose transporter 1


Haemangioma stem cells


Hypoxia-inducible factor


Infantile haemangioma


Neodym-dotted Yttrium-aluminum-granate laser


Posterior fossa-haemangioma-arterial-cardiac-eye anomaly


Randomized controlled trial


Vascular endothelial growth factor (receptor)



We thank Laboratoires Pierre Fabre Dermatologie, Inc., for sponsoring the meeting in Castres and for the technical support of the consensus process. Drs. Etienne André and Alain Delarue kindly acted as moderators of the discussion process.

Compliance with ethical standards

The manuscript complies to the ethical rules applicable to the European Journal of Pediatrics.

Conflict of interest

Pierre Fabre Inc., France, hosted the initial meeting of the Expert Group in Castres/France.

Author’s contributions

All coauthors attended the initial meeting and participated in the discussion of topics and in the design of the consensus paper. PHH wrote the initial draft of the manuscript which was then circulated to all coauthors. Comments and annotations of all coauthors were included in subsequent drafts. The final version of the manuscript was approved by all coauthors.

Supplementary material

431_2015_2570_MOESM1_ESM.doc (358 kb)
ESM 1 (DOC 357 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Peter H. Hoeger
    • 1
    Email author
  • John I. Harper
    • 2
  • Eulalia Baselga
    • 3
  • Damien Bonnet
    • 4
  • Laurence M. Boon
    • 5
  • Marta Ciofi Degli Atti
    • 6
  • Maya El Hachem
    • 7
  • Arnold P. Oranje
    • 8
  • Agneta Troilius Rubin
    • 9
  • Lisa Weibel
    • 10
  • Christine Léauté-Labrèze
    • 11
  1. 1.Department of Paediatrics and Paediatric DermatologyCatholic Children’s Hospital WilhelmstiftHamburgGermany
  2. 2.Department Paediatric DermatologyGreat Ormond Street Hospital for ChildrenLondonUK
  3. 3.Department Paediatric DermatologyHospital de la Santa Creu I Sant PauBarcelonaSpain
  4. 4.M3C-Department Paediatric CardiologyUniversité Paris Descartes, Hôpital Universitaire Necker-Enfants MaladesParisFrance
  5. 5.Division Plastic Surgery, Ctr. Vascular AnomaliesCliniques Universitaires St LucBrusselsBelgium
  6. 6.Clinical Epidemiology UnitOspedale Pediatrico Bambino Gesù, IRCCSRomeItaly
  7. 7.Dermatology UnitOspedale Pediatrico Bambino Gesù, IRCCSRomeItaly
  8. 8.Department of DermatologyMaasstad HospitalRotterdamNetherlands
  9. 9.Centre for Laser and Vascular Anomalies, Department of DermatologySkane University HospitalMalmöSweden
  10. 10.Department of DermatologyUniversity Hospital and University Children’s HospitalZürichSwitzerland
  11. 11.Department Paediatric DermatologyCHU de Bordeaux, HôpitalPellegrin-EnfantsBordeauxFrance

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