Comparative Outcomes of Propranolol and Corticosteroids in Infantile Haemangiomas: A Systematic Review and Meta-Analysis

Aims/Background: Infantile haemangiomas (IH) are the most common benign vascular tumours of infancy. Oral propranolol has become the first-line treatment, while corticosteroids remain second-line or adjunctive options when propranolol is contraindicated or insufficient. This meta-analysis provides updated comparative evidence on the efficacy and safety of oral propranolol versus oral and intralesional corticosteroids in paediatric IH. Methods: A systematic search of Ovid MEDLINE, Embase, Cochrane Library, CINAHL, and other databases was conducted on April 15, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data were synthesised using a random-effects model. Results: Fifteen studies met inclusion criteria (n = 1841). Propranolol demonstrated a significantly higher overall treatment effectiveness compared to corticosteroids (odds ratio [OR]: 4.96, 95% confidence interval [CI]: 2.19–11.26; p = 0.0001). In subgroup analyses by route, propranolol was superior to oral corticosteroids (OR: 6.56, 95% CI: 1.98–21.73; p = 0.002), but showed no difference compared to intralesional corticosteroids. Overall adverse event odds were lower with propranolol (OR: 0.27, 95% CI: 0.10–0.71; p = 0.008), specifically when compared against oral corticosteroids (OR: 0.17, 95% CI: 0.03–0.88; p = 0.03) and in treatment-related ulceration rates (OR: 0.18, 95% CI: 0.08–0.42; p < 0.0001). No significant differences were observed between treatment groups regarding overall treatment duration, recurrence rate, or surgical resection rate. Conclusion: Propranolol was associated with greater overall treatment effectiveness and a lower incidence of adverse events than corticosteroids. Greater effectiveness was observed compared with oral corticosteroids, but not intralesional corticosteroids. Intralesional corticosteroids may remain appropriate for selected patients, highlighting the importance of considering corticosteroid route and individual lesion characteristics when selecting treatment. Systematic Review Registration: PROSPERO (CRD420251025754).