Systemic (internal) treatments:

For larger or more aggressive hemangiomas, treatment usually consists of an oral medication, particularly an oral form of prednisolone (steroid) or oral propranolol, to prevent complications.

Oral propranolol:

The use of propranolol – a medication normally used for treating high blood pressure - for hemangiomas was first reported in 2008. Propranolol has been reported to stop hemangiomas from growing and causing actual shrinkage of hemangiomas. Studies are underway to determine the safety and efficacy of this treatment option. Potential side effects include low blood sugar, slowing of the heart rate, and lowering of blood pressure. Patients with asthma should not be treated with this medication.

Read more about propranolol for the treatment of hemangiomas

  • This two-month-old male presented with a large hemangioma of the lateral cheek region.  He was treated with oral propranolol, and at 1 year of age (second photo), marked improvement is noted.

Oral prednisolone

Oral corticosteroids (usually prednisolone) have been used for more than 40 years to treat hemangiomas. They are quite effective at stopping hemangioma growth and actually shrink hemangiomas in approximately 30% of cases. Oral steroids have many potential side effects which can be discussed with your provider. They are typically given for several months and toward the end of treatment the dosage is gradually reduced.

  • This child's hemangioma was treated with systemic prednisolone from 1—7 months of age.

  • This child was started on corticosteroids at one month of age and was tapered off by age eight months. At age two years had two pulsed dye laser treatments. A surgery to improve lip contour is planned at age four years

  • This child's hemangioma was treated with systemic prednisolone from 5 weeks—10 months of age.