With propranolol therapy, the therapeutic efficacy is observed immediately. Sans et al. used propranolol at a dose of 2-3 mg/kg/day in 32 children with severe IH and noticed immediate changes in colour (within 24 hours) and softening in all the cases. Airway obstructive symptoms and haemodynamic compromise regressed within 48 hours.[29] Hermans et al. also reported improvement of respiratory symptoms in airway haemangioma within hours of treatment initiation with propranolol.[31] Propranolol also seems to be a promising drug for ulcerated haemangiomas. Painful ulceration in haemangioma has been reported to heal completely within 2 months. In a recent study of 20 children with ulcerated IH, oral propranolol significantly decreased the duration of ulceration compared with the control group (8.7 vs. 22.4 weeks, P < 0.01).[43] All these published observations suggest that oral propranolol can be considered as the best therapeutic option in cases with airway and other complicated IH. Figures 2 and 3 show near complete response to propranolol in two of our cases.