Commentary on Moodley S et al. “Shouldn’t Propranolol be Used to Treat All Hemangiomas?”

I was asked to provide a commentary for “Shouldn’t Propranolol be Used to Treat All Hemangiomas?” by Moodley et al. (Aesth Plast Surg, 2015. doi:10.​1007/​s00266-015-0557-x). I commend the authors for implicitly recognizing that it is no longer appropriate to take the laissez faire approach to hemangiomas of infancy. Whilst hemangiomas will eventually improve, they will not necessarily “disappear,” as parents are often erroneously counseled. In fact, the larger a hemangioma becomes, the less likely one will be pleased with the ultimate result, whether treated medically or not. The natural process of proliferation followed by involution often produces saggy anetoderma, which, in certain anatomic locations is obvious and draws negative attention.

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