Evaluation of the efficacy of oral propranolol combined with pulsed dye laser versus monotherapy with oral propranolol in the treatment of mixed infantile hemangiomas.

Oral propranolol is first-line for problematic infantile hemangiomas (IHs) but often leaves superficial residual lesions. This study assessed the efficacy and safety of adding pulsed dye laser (PDL) to propranolol versus propranolol alone for mixed IHs. This single-center retrospective cohort study included children with mixed IHs treated from January 2020 to September 2024, assigned to oral propranolol alone or with PDL. VESS (Vascular Density, Color Intensity, Texture Change) scores at 3 months, Achauer grade ≥ 4 at 1, 3, and 6 months, and regression metrics at 6 months were measured. Safety, parent-reported outcomes, treatment duration, and 12-month sequelae were also recorded. A total of 247 children were included (132 propranolol, 115 combination). The combination group had lower VESS scores at 3 months (all P < 0.010). Achauer grade ≥ 4 was more frequent at all time points (40.87% vs. 22.73% at 1 month, P = 0.002). Area reduction (75.66% vs. 70.75%, P < 0.001), thickness reduction (P = 0.024), and colorimetric ΔE (P = 0.003) were greater. Superficial erythema resolution improved (P = 0.002) with similar deep mass volume reduction. Satisfaction with color improvement (P < 0.001) and quality of life (P < 0.001), and shorter treatment duration (5.79 vs. 6.55 months, P = 0.007) favored the combined group. Recurrence (2.61% vs. 9.85%, P = 0.041) and residual telangiectasia (5.22% vs. 12.88%, P = 0.039) were lower. Transient purpura occurred only with PDL (22.61% vs. 0%, P < 0.001); other events were comparable. Adding PDL to oral propranolol significantly improves superficial clearance and aesthetic outcomes, accelerates global improvement, and reduces long-term recurrence and residual telangiectasia in mixed IHs.