Topical Timolol for Infantile Hemangiomas: Putting a Note of Caution in “Cautiously Optimistic”

McMahon, Patrick J.; Oza, Vikash S.; Frieden, Ilona J.

doi:10.1111/j.1525-1470.2011.01685.x

Cited by 78 publications

(85 citation statements)

References 22 publications

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“…Topical timolol solution is a nonselective b-adrenergic receptor inhibitor that was approved in 1978 for the treatment of glaucoma and has been safely used as first-line therapy for pediatric glaucoma for .30 years. 12,14 A number of case reports and case series have observed the efficacy of timolol maleate 0.5% gel for the treatment of IHs [15][16][17][18][19][20][21][22] ; however, concern has been raised regarding its safety. 12 This blinded, randomized, placebo-controlled study aims to begin to answer these questions relating to the safety and efficacy of topical timolol maleate 0.5% gel in the setting of small, superficial focal IHs in infants aged 5 to 24 weeks.…”

Section: What This Study Addsmentioning

confidence: 99%

“…19,20,22 However, concern has been voiced regarding the potential systemic absorption and side effects that may arise from topical timolol maleate gel and what specific monitoring requirements are needed while receiving therapy. McMahon et al 12 estimated that 1 drop of 0.5% timolol gel-forming solution may equate to 2 to 8 mg of oral propranolol hydrochloride. As a comparison, oral propranolol hydrochloride is generally used at a dose of 1 mg/kg 2 to 3 times a day.…”

Section: Safetymentioning

confidence: 99%

“…In the pediatric ophthalmology literature, systemic bioavailability of timolol solution applied to mucosal surfaces has been estimated to be as high as 60% to 80% 32 and has been attributed to cases of apnea, asthma, bradycardia, dizziness, and dissociated behavior. 12 In the studies of timolol maleate solution for the treatment of IHs, a case report of a 4-month-old girl developing blepharoptosis after treatment of a thinplaque IH on the upper eyelid with 0.5% timolol solution has been described. 16 The systemic absorption of timolol maleate gel formulation is considered to be significantly less than that of timolol maleate solution and hence has been favored in more recent studies.…”

Section: Safetymentioning

confidence: 99%

“…Efficacy was assessed by performing blinded volume measurements at weeks 0, 1, 2, 3,4,8,12,16,20, and 24 and blinded investigator photograph scoring at weeks 0, 12, and 24. Safety was assessed by measuring heart rate and systolic and diastolic blood pressure at weeks 0, 1, 2, 3,4,8,12,16,20, and 24.…”

Section: What This Study Addsmentioning

confidence: 99%

“…One drop of timolol maleate 0.5% gel has been estimated to contain 0.25 mg of timolol. 12 The first application was conducted in the outpatient department, and blood pressure and heart rate were measured just before application and 1 hour after application of placebo or timolol maleate 0.5% gel. Heart rate and blood pressure measurements were compared with age-related reference ranges.…”

Section: Figurementioning

confidence: 99%

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RCT of Timolol Maleate Gel for Superficial Infantile Hemangiomas in 5- to 24-Week-Olds

Chan¹,

McKay²,

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT:The systemic nonselective b-blocker propranolol hydrochloride is increasingly used as firstline management for infantile hemangiomas. Superficial nonulcerating lesions do not require systemic medications. Case series have suggested the efficacy of timolol; however, its safety has been questioned. WHAT THIS STUDY ADDS:This randomized controlled trial indicates that timolol maleate 0.5% gel is a well-tolerated, safe, and effective treatment of superficial infantile hemangiomas. abstract OBJECTIVE: Timolol maleate 0.5% gel is a safe and effective medication for treating superficial infantile hemangiomas (IHs) in infants with a median age of 9 weeks.METHODS: Forty-one infants who had superficial IHs without ulceration and not near mucosal surfaces were recruited and randomly assigned to placebo and treatment (timolol maleate 0.5% gel) groups. Efficacy was assessed by performing blinded volume measurements at weeks 0, 1, 2, 3,4,8,12,16,20, and 24 and blinded investigator photograph scoring at weeks 0, 12, and 24. Safety was assessed by measuring heart rate and systolic and diastolic blood pressure at weeks 0, 1, 2, 3, 4, 8, 12, 16, 20, and 24. RESULTS: Fifteen of the 19 infants receiving treatment and 17 of the 22 infants receiving placebo completed the study. Significant color change on the blinded photographic scores was noted at week 24 of the study (P = .003). There was a significantly higher proportion of treated IHs that reduced in size by .5% at weeks 20 and 24 (P , .02). The predicted proportion of IH volume change was also significantly less for treated IHs from week 16 onward when compared with placebo (P , .05). There was no significant variation in blood pressure and heart rate between the groups. CONCLUSIONS: Topical timolol maleate 0.5% gel with a maximum dose of 0.5 mg per day is a safe and effective option for small superficial IHs that have not ulcerated and are not on mucosal surfaces. Pediatrics

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Section: What This Study Addsmentioning

confidence: 99%

Section: Safetymentioning

confidence: 99%

Section: Safetymentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

See 3 more Smart Citations

RCT of Timolol Maleate Gel for Superficial Infantile Hemangiomas in 5- to 24-Week-Olds

Chan¹,

McKay²,

et al. 2013

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Topical Timolol for Paronychia and Pseudopyogenic Granuloma in Patients Treated With Epidermal Growth Factor Receptor Inhibitors and Capecitabine

et al. 2018

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Paronychia and pseudopyogenic granuloma (pseudo-PG) are relatively common and difficult-to-manage adverse effects in patients undergoing treatment with epidermal growth factor receptor inhibitors and capecitabine. 1 Recently, Piraccini et al 2 reported the successful treatment of chemotherapy-induced fingernail PGs with topical propranolol, 1%, cream. The aim of this study was to evaluate the efficacy and tolerability of topical timolol, 0.5%, gel as a treatment of paronychia and pseudo-PG induced by antineoplastic agents.

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Dermatoses and Haemangiomas of Infancy

Higgins

Glover

2016

Rook's Textbook of Dermatology, Ninth Edition

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An overview of the most common or important dermatoses occurring in the first year of life is presented, under the categories of inflammatory, infective, reactive, developmental/genetic and miscellaneous. Emphasis is given to the key features relative to this age group, and more detailed accounts of specific disorders are found in the specialist sections elsewhere in these volumes. A section on infantile and congenital haemangiomas is also included.

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Topical Timolol for Infantile Hemangiomas: Putting a Note of Caution in “Cautiously Optimistic”

Cited by 78 publications

References 22 publications

RCT of Timolol Maleate Gel for Superficial Infantile Hemangiomas in 5- to 24-Week-Olds

RCT of Timolol Maleate Gel for Superficial Infantile Hemangiomas in 5- to 24-Week-Olds

Topical Timolol for Paronychia and Pseudopyogenic Granuloma in Patients Treated With Epidermal Growth Factor Receptor Inhibitors and Capecitabine

Dermatoses and Haemangiomas of Infancy

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