# Haemangioma or Lymphangioma - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Hemangioma - StatPearls - NCBI Bookshelf (NBK538232) - https://www.ncbi.nlm.nih.gov/books/NBK538232/ · Lymphangioma - StatPearls - NCBI Bookshelf (NBK470333) - https://www.ncbi.nlm.nih.gov/books/NBK470333/ · HEMANGEOL (propranolol hydrochloride) oral solution, DailyMed label SetID b6f9dd2a-632b-87eb-70f0-b2064d7ed48a, Dosage and Administration · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class SD28 - condition scope only, no dose - Verified date: 2026-09 ## Verified against - HEMANGEOL (propranolol hydrochloride) oral solution, DailyMed label SetID b6f9dd2a-632b-87eb-70f0-b2064d7ed48a, Dosage and Administration - Hemangioma - StatPearls - NCBI Bookshelf (NBK538232) - https://www.ncbi.nlm.nih.gov/books/NBK538232/ - Lymphangioma - StatPearls - NCBI Bookshelf (NBK470333), Treatment / Management ## Treatment metadata - Propranolol — 10 mg — oral.solid - Recognition, monitoring and referral (Referral & Advice) ## Complete treatment card ```text HAEMANGIOMA OR LYMPHANGIOMA Sources: Hemangioma - StatPearls - NCBI Bookshelf (NBK538232) - https://www.ncbi.nlm.nih.gov/books/NBK538232/ · Lymphangioma - StatPearls - NCBI Bookshelf (NBK470333) - https://www.ncbi.nlm.nih.gov/books/NBK470333/ · HEMANGEOL (propranolol hydrochloride) oral solution, DailyMed label SetID b6f9dd2a-632b-87eb-70f0-b2064d7ed48a, Dosage and Administration · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class SD28 - condition scope only, no dose Review status: REVIEWED against 3 sources listed above (2026-09) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Superficial lymphangioma (lymphangioma circumscriptum) can cause itching, pain, burning, weeping fluid, infection, or cosmetic concern [itching] - Cavernous lymphangioma typically shows up in infancy as a painless, poorly defined swelling under normal-looking skin SIGNS - what you find (5) - Lymphangioma circumscriptum appears as clustered, translucent or blood-tinged vesicle-like bumps resembling frog spawn [blisters · vesicles] - In the genital area, the surface can look warty and be mistaken for genital warts [genital warts] - Cavernous lymphangioma is often mistaken clinically for a cyst or a lipoma [cyst] - Cystic hygroma is a soft swelling of variable size on the neck, armpit, or groin that tends to enlarge unless surgically removed - A hygroma at the back of the neck can point to Turner syndrome, hydrops fetalis, or a similar congenital condition [hydrops fetalis] TESTS (3) - Diagnosis is usually made clinically; dermoscopy or biopsy can confirm it, and imaging shows depth and extent - Dermoscopy shows either yellow lacunae with pale borders, or yellow-pink lacunae mixed with dark-red or bluish ones when blood is present - Cystic hygromas can be seen before birth on transabdominal or transvaginal ultrasound, and MRI helps map how far a lesion extends IF NOT THIS - what else fits (4) - Cutaneous melanoma is on the differential for a pigmented or vascular-looking lesion - Herpes zoster and lymphangiectasia are also on the differential - Stewart-Treves syndrome is on the differential - Cutaneous lipomas are also on the differential Source StatPearls "Lymphangioma" - disease-level clinical article Status traced to the source above Rx: Complicated infantile haemangioma - specialist-initiated | Recognition and referral COMPLICATED INFANTILE HAEMANGIOMA - SPECIALIST-INITIATED 1. PROPRANOLOL [1st line] Adult Not applicable - infantile haemangioma is treated in infancy (see the paediatric dose). Lymphangioma is not treated with a systemic drug - Not applicable Peds 0.6-1.7 mg/kg/dose (Twice daily, at least 9 hours apart, and titrated - the low figure is the starting dose and the high figure the maintenance dose, not a range to pick from. The label: "The recommended starting dose of HEMANGEOL is 0.15 mL/kg (0.6 mg/kg) twice daily, taken at least 9 hours apart. After 1 week, increase the daily dose to 0.3 mL/kg (1.1 mg/kg) twice daily. After 2 weeks of treatment, increase the dose to 0.4 mL/kg (1.7 mg/kg) twice daily and maintain this for 6 months." Treatment is initiated at ages 5 weeks to 5 months, and the dose is readjusted periodically as the child's weight increases. The two sources give different daily totals for maintenance: 1.7 mg/kg twice daily is the licensed figure, while StatPearls states 2 mg/kg/day; both are recorded here rather than one being chosen. Two bounds on the table above. The label contraindicates it in an "infant weighing less than 2 kg", which is the lower limit; and it states that "Safety and effectiveness for infantile hemangioma have not been established in pediatric patients greater than 1 year of age", which is why the table stops. The 12 kg ceiling is a bound derived from that one-year limit, not a weight the label itself states - a child heavier than this is outside the evidence for the drug in this condition, not merely off the end of a table.) Age restriction: maximum 12 months Not for children under 2 kg 3kg -> 1.8-5.1 mg/dose 4kg -> 2.4-6.8 mg/dose 5kg -> 3-8.5 mg/dose 6kg -> 3.6-10.2 mg/dose 7kg -> 4.2-11.9 mg/dose 8kg -> 4.8-13.6 mg/dose 9kg -> 5.4-15.3 mg/dose 10kg -> 6-17 mg/dose 11kg -> 6.6-18.7 mg/dose 12kg -> 7.2-20.4 mg/dose This mg/kg figure applies up to 12 kg only - above that, dose on specialist advice Choice Alternatives, all named by the same article and all decided by the specialist, not in primary care: oral prednisone as an alternative systemic therapy, which has to be tapered slowly over weeks to months; topical timolol for smaller, superficial, uncomplicated lesions; and intralesional or topical corticosteroid for small focal lesions. No dose is given for those here because the article states none for timolol and the systemic steroid choice belongs to the treating service. Source HEMANGEOL (propranolol hydrochloride) oral solution, DailyMed label SetID b6f9dd2a-632b-87eb-70f0-b2064d7ed48a, Dosage and Administration; first-line status and the 2 mg/kg/day figure from Hemangioma - StatPearls - NCBI Bookshelf (NBK538232) - https://www.ncbi.nlm.nih.gov/books/NBK538232/ Why Non-selective beta blocker. StatPearls: "Most infantile hemangiomas do not require treatment because they resolve on their own. Complicated infantile hemangiomas requires treatment. Recently, beta blockers such as oral propranolol (2mg/kg/day) have been shown to be effective as first line therapy." The amounts and the titration come from the licensed paediatric product, whose only indication is proliferating infantile haemangioma requiring systemic therapy. Caution Specialist-initiated. The licensed indication is a proliferating infantile haemangioma that needs systemic therapy - most infantile haemangiomas need no treatment at all because they resolve on their own, so the decision to start is the referral service's. RED FLAG - Contraindicated in a premature infant less than 5 weeks past the due date, an infant weighing less than 2 kg, asthma or any history of bronchospasm, a heart rate below 80 beats per minute, heart block greater than first degree, decompensated heart failure, a blood pressure below 50/30 mmHg, and phaeochromocytoma. Hypoglycaemia can happen at any time during treatment, and propranolol masks its adrenergic warning signs - particularly tachycardia, palpitations and sweating. Give it during or right after a feed, and skip the dose if the child is not eating or is vomiting. Monitor heart rate and blood pressure for 2 hours after the first dose and after every dose increase. Egypt lists no paediatric propranolol liquid. The register carries 10 mg and 40 mg tablets and a 1 mg/ml intravenous ampoule only, so the small milligram amounts an infant needs have to be prepared by a pharmacy rather than measured from a tablet at the bedside. Confirm how the dose will actually be made up before starting. If the haemangioma recurs after treatment stops, the label allows treatment to be re- started. Egypt INDOLOL 10 MG 50 TAB KAHIRA 12.50 EGP (0.25/unit) PROLOL 10 MG 50 TABS. EIPICO 16.25 EGP (0.33/unit) INDERAL 10 MG 50 TABS ASTRA ZENECA 75.00 EGP (1.50/unit) RECOGNITION AND REFERRAL 2. RECOGNITION, MONITORING AND REFERRAL (REFERRAL & ADVICE)[2nd line] Adult Benign vascular or lymphatic malformations, often congenital, presenting as a raised birthmark that blanches on pressure. Most infantile haemangiomas involute on their own; larger or problematic lesions near the eye, airway or genitalia, or ones that ulcerate, are treated with the oral propranolol above under specialist supervision, so the GP's role is monitoring, timely referral, and continuing the prescription safely once it is started. A lymphangioma is a different problem with no systemic drug: the treatment of choice is surgical excision, with laser, cryotherapy, compression and sclerotherapy as the other reported options. - Refer, with advice Peds Both conditions usually present in infancy or childhood; the pathway is the same - recognise, monitor and refer. The propranolol row above carries the weight-based dose for the haemangioma. Source No dose - a recognition and referral pathway. The lymphangioma statement is from Lymphangioma - StatPearls - NCBI Bookshelf (NBK470333), Treatment / Management Why Benign vascular or lymphatic malformations, often congenital, presenting as a raised birthmark that blanches on pressure. Most infantile haemangiomas involute on their own; larger or problematic lesions near the eye, airway or genitalia, or ones that ulcerate, are treated with the oral propranolol above under specialist supervision, so the GP's role is monitoring, timely referral, and continuing the prescription safely once it is started. A lymphangioma is a different problem with no systemic drug: the treatment of choice is surgical excision, with laser, cryotherapy, compression and sclerotherapy as the other reported options. Caution Recurrence after surgery for a lymphangioma is common - reported as high as 23% over follow-up of up to 81 months - so a lesion that comes back is not necessarily a failed operation. RED FLAG - Cellulitis and lymphatic fluid leakage are common complications of lymphangioma circumscriptum. RED FLAG - Large cystic hygromas of the neck can cause dysphagia and respiratory problems. RED FLAG - A haemangioma near the eye, airway, or genitalia (risk of function- threatening growth), ulceration or bleeding of the lesion, or rapid growth in early infancy needing specialist review before it enlarges further. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)