Efficacious Healing of Ulcerated Infantile Hemangiomas Using Topical Timolol

Abstract

Summary:Infantile hemangiomas (IHs) are the most common benign pediatric soft-tissue tumors. Ulceration—the most frequent complication of IH—tends to heal poorly and is associated with pain, bleeding, infection, and scarring. Mainstay treatment modalities include propranolol (β-blocker) and corticosteroids, whose effectiveness is countered by a need for long-term medication and risk of systemic adverse effects and ulcer recurrence. A 3-month-old infant presented to us with a large, medial thigh-ulcerated IH that progressed despite 2 prior months of dressings and topical antimicrobials. Topical timolol 0.5% thrice daily was initiated, and significant healing was evident at 1 week, with complete healing at 1 month. Timolol was stopped after 3 months, and at 18 months after cessation of timolol, there was no ulcer recurrence. This novel therapy for ulcerated IH seems to have many advantages such as rapid efficacy with easy application, no systemic adverse effects and no long-term recurrence, and current literature describing similar advantages justifies the use of this treatment modality in infants.

Medical treatment of infected, ulcerative infantile hemangioma covered with pseudomembrane

“…4,10 Recent studies have described good response to treatment with topical timolol as well as with brimonidine-timolol cream. 11,12 Surgical treatment of IH is infrequently indicated but is an option according to the AAP recommendations. Indications for surgical management include hemangiomas which are ulcerating or obstructing an eye or airway and have not responded to medical management.…”

Medical, Surgical, and Wound Care Management of Ulcerated Infantile Hemangiomas: A Systematic Review

“…Of the 1230 patients reviewed in our study, 613 were treated with systemic antibiotics, 200 with pulsed dye laser, 197 with oral propranolol, 54 with atenolol, 46 with topical timolol, 25 with pulsed dye laser and Nd:YAG laser, 12 with topical becaplermin, 12 with surgical resection, 8 with wound care alone, 5 with captopril, 1 with vincristine, 19 with combination therapies, and 38 with other, less common, treatment modalities (Table 2). 55 Boos and Castelo-Soccio 56 Cante et al 45 Chang and Kang 4 Neri et al 46 Thomas et al 28 Tlougan et al 57 Weibel et al 31 58 Bagazgoitia et al 59 Ben-Zvi and Gass 60 Bernabeu-Wittel et al 61 Betlloch-Mas et al 9 Bouras et al 62 Cavalli et al 13 Gidaris et al 63 Gulati and Jury 10 Hermans et al 64 Hong and Fischer 47 Kim et al 2 Lanoel et al 65 Morais et al 11 Mousa et al 14 Naouri et al 66 Nelson et al 67 Oksiuta et al 68 Pavlakovic et al 15 Saaiq et al 69 Sadykov et al 70 Saint-Jean et al 8 Sans et al 71 Sharma et al 72 Tan et al 12 Thomas et al 73 Tiwari et al 7 Vercellino et al 74 76 Hermosa et al 33 Lacour et al 36 Morelli et al 34 Ward et al 50 Bookout et al 41 Chang et al…”

“…These goals were achieved with multiple dressings, including silicone dressings and hydrocolloids, which were used in addition to other therapies in multiple studies. 4,20,[44][45][46][47] Debridement is not always necessary, and if needed, autolytic debridement is preferred. 51…”

Topicalbeta‐blockersin dermatologic therapy

“…In the past 5 years, several case reports, case series, prospective and retrospective studies have supported the use of topical beta‐blockers such as timolol and propranolol in PG treatment 22,24–29 . Timolol maleate in 0.5% gel formulations is the most widely used topical beta‐blocker for PG 25 .…”