IMPORTANCE: Propranolol therapy is changing the treatment paradigm for infantile 
hemangioma. This study addresses the effect of propranolol therapy on the 
treatment of nasal infantile hemangioma (NIH), an area that often does not 
respond to medical therapy.
OBJECTIVE: To determine if propranolol treatment is associated with fewer 
invasive treatments for NIH.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study conducted within a 
single pediatric institution's multidisciplinary vascular anomaly program for 
patients with NIH treated between January 1, 2003, and December 31, 2011. Three 
NIH cohorts were compared: prepropranolol (20 in group 1; 2003-2009), 
propranolol (25 in group 2; 2009-2011), and nonpropranolol (13 in group 3; 
2009-2011) treatment.
INTERVENTIONS: Analysis of systemic medical, laser, or surgical therapies for 
NIH.
MAIN OUTCOMES AND MEASURES: The study plan was created to detect a change in 
invasive therapy for NIH. Data collected included presenting age, sex, affected 
nasal subunits, infantile hemangioma morphologic characteristics, treatment type 
and number, and primary treating service. An NIH grading system, based on nasal 
subunit involvement, helped quantify treatment change. Descriptive statistics 
summarized data, and a Cox proportional hazards regression model evaluated 
propranolol use and the likelihood of invasive treatments (surgical excision or 
laser).
RESULTS: Of the 95 patients identified, 58 met inclusion criteria: 20 in group 1 
(mean age, 4.8 months), 25 in group 2 (mean age, 4.9 months), and 13 in group 3 
(mean age, 4.9 months). Nasal infantile hemangiomas involved the nasal tip 
subunit in 33 of 58 patients (56.9%). Eight of 13 patients (61.5%) in group 3 
frequently had small NIH (grade 1). Patients in group 2 were less likely to 
undergo any invasive treatments (relative risk, 0.44; 95% CI, 0.27-0.73), have 
surgical excision only (0.45; 0.15-1.38), or undergo laser treatment only (0.44; 
0.27-0.78) compared with those in group 1. Patients with higher-grade NIH had 
more medical or invasive therapy, but invasive procedures were carried out in 
each subgroup defined by grade.
CONCLUSIONS AND RELEVANCE: Patients with isolated propranolol-treated NIH were 
less likely to undergo invasive treatment, but despite its implementation, the 
need for invasive treatment was not totally supplanted by its use.