{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T06:08:23Z","timestamp":1763705303081,"version":"3.44.0"},"reference-count":24,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,4,20]]},"abstract":"<jats:p>We present a female infant with a right-sided facial and neck haemangioma, from a remote, resource-poor community in rural Guatemala. She received first-line treatment, propranolol, with marked reduction in tumour size and erythema. Treatment was stopped after 35\u2009weeks due to recurrent diarrhoea and sustained weight loss. Propranolol can be used to safely treat infants with haemangiomas in remote, rural communities if there is adequate follow-up, education and communication. Periocular haemangiomas should be treated promptly to avoid visual impairment. Infants with large facial haemangiomas should be screened for <jats:bold>P<\/jats:bold>osterior fossa anomalies, <jats:bold>H<\/jats:bold>emangioma, <jats:bold>A<\/jats:bold>rterial anomalies, <jats:bold>C<\/jats:bold>ardiac anomalies, and <jats:bold>E<\/jats:bold>ye anomalies (PHACE) syndrome, and specialists should be involved. The case also highlights the difficulty of providing treatment for a complex illness when basic health needs, such as food security and water sanitation, are limited.<\/jats:p>","DOI":"10.1136\/bcr-2017-219782","type":"journal-article","created":{"date-parts":[[2017,5,16]],"date-time":"2017-05-16T08:35:11Z","timestamp":1494923711000},"page":"bcr-2017-219782","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Use of propranolol in a remote region of rural Guatemala to treat a large facial infantile haemangioma"],"prefix":"10.1136","volume":"2017","author":[{"given":"Vera","family":"Goldberg","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris","family":"Martinez","sequence":"additional","affiliation":[{"name":"Wuqu' Kawoq, Santiago Sacatep\u00e9quez, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katia","family":"Cnop","sequence":"additional","affiliation":[{"name":"Wuqu' Kawoq, Santiago Sacatep\u00e9quez, Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7274-8315","authenticated-orcid":false,"given":"Peter","family":"Rohloff","sequence":"additional","affiliation":[{"name":"Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,5,16]]},"reference":[{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1470.2011.01569.x"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1404710"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199907153410307"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2008.05.043"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.5","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198203000-00002"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-2767"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.7","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jaapos.2009.09.014","article-title":"Relationship of infantile periocular hemangioma depth to growth and regression pattern","volume":"13","author":"Tambe","year":"2009","journal-title":"J AAPOS"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.8","first-page":"5","article-title":"Treatment of infantile hemangiomas with beta-blockers: a review","volume":"18","author":"Shah","year":"2013","journal-title":"Skin Therapy Lett"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.0736-8046.2004.21101.x"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.10","doi-asserted-by":"publisher","DOI":"10.1542\/peds.101.3.446"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.11","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jpeds.2016.07.054","article-title":"PHACE syndrome: consensus-derived diagnosis and care recommendations","volume":"178","author":"Garzon","year":"2016","journal-title":"J Pediatr"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.12","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-3166"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.13","first-page":"479","article-title":"[Infantile hemangioma and propranolol: a therapeutic \"revolution\". Literature review]","volume":"34","author":"Yilmaz","year":"2013","journal-title":"Rev Med Brux"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.14","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/SAP.0000000000000506","article-title":"Is propranolol safe and effective for outpatient use for infantile hemangioma? a prospective study of 679 cases from one center in China","volume":"76","author":"Chang","year":"2016","journal-title":"Ann Plast Surg"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2012.02521.x"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.16","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s40801-015-0052-3","article-title":"Therapeutic Effect of Propranolol in Mexican Patients with Infantile Hemangioma","volume":"3","author":"Castaneda","year":"2016","journal-title":"Drugs Real World Outcomes"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.17","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-1691"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.18","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1007\/s12325-016-0391-9","article-title":"The Role of the Pharmacist in the Treatment of Patients with Infantile Hemangioma Using Propranolol","volume":"33","author":"Castaneda","year":"2016","journal-title":"Adv Ther"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.19","unstructured":"WHO Multicentre Growth Reference Study Group. Child growth standards [Internet]. Geneva: World Health Organization, 2006. http:\/\/www.who.int\/childgrowth\/standards\/technical_report\/en\/"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.20","doi-asserted-by":"crossref","unstructured":"Natawidjaja R , Wang E . Treatment of complex infantile haemangioma in a resource-poor setting. BMJ Case Rep 2014. https:\/\/www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu\/pmc\/articles\/PMC4112300\/ doi:10.1136\/bcr-2014-205330","DOI":"10.1136\/bcr-2014-205330"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.21","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.5604\/17322693.1120990","article-title":"Treatment of problematic infantile hemangiomas with propranolol: a series of 40 cases and review of the literature","volume":"68","author":"Oksiuta","year":"2014","journal-title":"Postepy Hig Med Dosw"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.22","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/SAP.0000000000000390","article-title":"Local administration of \u03b2-blockers for infantile hemangiomas: a systematic review and meta-analysis","volume":"74","author":"Ovadia","year":"2015","journal-title":"Ann Plast Surg"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.23","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jaapos.2015.11.012","article-title":"Topical timolol maleate 0.5% solution for the management of deep periocular infantile hemangiomas","volume":"20","author":"Painter","year":"2016","journal-title":"J AAPOS"},{"key":"2025082722560628000_2017.may15_1.bcr-2017-219782.24","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.survophthal.2015.08.006","article-title":"Review of topical beta blockers as treatment for infantile hemangiomas","volume":"61","author":"Painter","year":"2016","journal-title":"Surv Ophthalmol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-219782","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:56:14Z","timestamp":1756360574000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-219782"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5,16]]},"references-count":24,"alternative-id":["10.1136\/bcr-2017-219782"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-219782","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2017,5,16]]}}}