A NEW systematic review has shed light on the safety of beta blockers for treating PHACE syndrome, addressing concerns about stroke risk in patients with cerebrovascular and cardiovascular anomalies. PHACE syndrome—characterized by large segmental infantile hemangiomas and associated extracutaneous anomalies—has traditionally been managed with propranolol, a beta blocker revolutionizing care for infantile hemangiomas. However, concerns about potential adverse events, particularly stroke, have persisted due to the complex nature of the syndrome.
The study, conducted according to PRISMA guidelines and registered with PROSPERO, reviewed data on 403 patients across 105 studies. The overwhelming majority (94.5%) were treated with propranolol, while smaller numbers received nadolol or a combination of propranolol and atenolol. Notably, 71% of patients reported no adverse or atypical events, indicating the medication was well-tolerated in most cases.
Among the reported adverse events, the most common were sleep disturbances (9.8%) and gastrointestinal upset (7.8%). A smaller subset experienced worsening ulceration, peripheral arteriopathy, or Raynaud’s disease (7.4%). Two seizure events (1.0%) were noted, but neither led to loss of consciousness or EEG-confirmed epilepsy. One case of mild hemiparesis was reported, but it was deemed more likely related to the patient’s existing central nervous system anomalies rather than beta blocker use. Importantly, no strokes attributable to beta blockers were reported, providing reassurance about this treatment approach in the PHACE syndrome population.
While limitations, including incomplete follow-up data and potential patient duplication, were acknowledged, the findings provide valuable evidence supporting the safety of systemic beta blockers in managing PHACE syndrome. This data helps inform treatment guidelines and alleviate concerns surrounding the risk of severe adverse events like stroke.
Further research, particularly longitudinal and prospective studies, is recommended to better understand predictors of adverse events and optimize patient outcomes. This systematic review represents a significant step forward in addressing safety concerns and ensuring effective care for children with PHACE syndrome.
Reference: Finstad A et al. Safety of Beta Blockers for the Treatment of PHACE Syndrome: A Systematic Review. JAAD. 2025. doi: https://doi.org/10.1016/j.jaad.2024.11.077.
Anaya Malik | AMJ
