Topical Timolol Vs. Oral Propranolol for the Treatment of Superficial Infantile Hemangiomas

Abstract

Objective: Infantile hemangiomas (IHs) are the most common vascular tumors of infancy. Oral propranolol has achieved great success in treating IHs since 2008. To minimize the systemic side events caused by oral administration of propranolol, topical timolol started to be applied in the treatment of IHs, especially for superficial lesions.Methods: We treated 724 children with superficial IHs using oral propranolol or topical timolol, and investigated the efficacy and safety of the two treatment patterns.Results: Both oral propranolol and topical timolol achieved a satisfactory therapeutic outcome, with an effective response rate of 97 and 96.4%, respectively. No significant differences in visual analog scale (VAS) improvement between the two groups were observed. Occurrence rate of systemic adverse events for patients treated with oral propranolol (3.9%) was significantly higher than that for patients treated with topical timolol (0%). Clinical response was not associated with gender, duration of treatment, lesion location, lesion size, gestational age, and progesterone use during pregnancy, but closely associated with age at treatment initiation, which indicated that younger age at treatment initiation predicted for a better regression rate.Conclusions: We recommend that topical timolol instead of oral propranolol could be the first-line therapy for superficial IHs because of its good efficacy and improved safety.

The effectiveness and safety of topical β‐receptor blocker in treating superficial infantile haemangiomas: A meta‐analysis including 20 studies

“…In total, 4730 studies were identified initially after the literature search, of which 20 studies met the inclusion criteria in this meta‐analysis (after duplicates removed) . The selection process is shown in Figure , and the characteristics of the included reports are indicated in Tables and .…”

“…In total, 4730 studies were identified initially after the literature search, of which 20 studies met the inclusion criteria in this meta-analysis (after duplicates removed). [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The selection process is shown in…”

Infantile hemangioma

“…У мультицентричному когортному дослідженні доведено, що використання тімололу для лікування поверхневих ІГ має хороший клінічний ефект і добру переносимість [53]. Водночас, при порівнянні терапевтичного ефекту перорального застосування пропранололу і топічного використання ті-мололу в дітей із поверхневими ІГ виявлено однакові результати [68]. На сьогодні не існує загальноприйнятих схем лікування ІГ із використанням топічних E-блокаторів, проте, якщо буде дов ед е н а е ф е к т и в н і с т ь т а б е з п е ч н і с т ь ї х використання, то топічні E-блокатори можуть стати препаратами «першої лінії» в лікуванні невеликих і поверхневих ІГ, локалізованих у проблемних ділянках, зокрема повіках і зоні геніталій.…”

Failed Treatment of Classic Kaposi’s Sarcoma with Topical Timolol: Case Report and Review of the Literature

“…Topical timolol has largely been shown to be effective in the treatment of infantile hemangiomas with a 96% response rate [4,9]; in addition, evidence is emerging for its use in other conditions including pyogenic granulomas, recalcitrant wounds, chronic ulcers, and portwine stains [10]. The mechanism of action of timolol is unclear but previous studies have shown that KS lesions are dependent on β-adrenergic signaling for the reactivation of HHV-8, resulting in proliferation of KS [11].…”