Treatment of superficial infantile hemangiomas with timolol: Evaluation of short-term efficacy and safety in infants

Abstract

Timolol has been demonstrated to be efficacious in the topical treatment of superficial infantile hemangiomas (IHs). We conducted a prospective study to evaluate the short-term efficacy and safety of timolol in the treatment of superficial IH in Chinese infants. From March to November 2012, 124 patients with superficial IHs were included in the prospective study. The patients were divided into two groups: treatment (101 patients, the timolol drops were administered on the surface of the lesions three times daily, and erythromycin ointment was applied around the lesions) and observation (23 patients, without treatment). The results were categorized into three grades: class 1 (ineffective), class 2 (controlled growth) and class 3 (promoted regression). Within one week of the initiation of timolol treatment, a number of the lesions became softer and lighter in color. Four months following the initiation of timolol treatment, the overall response was class 1 in eight patients (7.9%), class 2 in 36 patients (35.6%) and class 3 in 57 patients (56.4%). Complete tumor regression was observed in 12 patients. No adverse effects were recorded during the treatment period. Among the patients in the observation group, there were 15 class 1 patients (65.2%), seven class 2 patients (30.4%) and only one class 3 patient (4.3%). In conclusion, timolol is an effective and safe treatment for superficial IH. In addition, it may be used in the treatment of proliferative superficial IH, particularly in infants within 6 months of age.

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

“…As shown in the results, age at treatment initiation was closely associated with therapeutic efficacy in both groups, with a higher regression rate for patients younger than 6 months old treated with either topical timolol or oral propranolol. These results were consistent with previous studies, which disclosed that better regression rate of IH lesions could be achieved in patients younger than 6 months old (10, 24). We hypothesized that this phenomenon was due to the characteristic growth behavior of IHs.…”

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

“…As shown in the results, age at treatment initiation was closely associated with therapeutic efficacy in both groups, with a higher regression rate for patients younger than 6 months old treated with either topical timolol or oral propranolol. These results were consistent with previous studies, which disclosed that better regression rate of IH lesions could be achieved in patients younger than 6 months old (10, 24). We hypothesized that this phenomenon was due to the characteristic growth behavior of IHs.…”

Propranolol for infantile hemangioma: Evaluating efficacy and predictors of response and rebound growth

“…We found that initiating propranolol before 6 months of age was an independently significant predictor of an excellent response to treatment. The latter accords with the observations of other studies depicting a higher regression rate of IH lesions when β‐blockers are commenced earlier than the age of 6 months 23‐25 . This finding stems from the interplay between the characteristic growth pattern of IH and the effect exerted by propranolol on IH endothelial cells.…”

Clinical Evaluation of Efficacy and Safety of Combined Topical Timolol and Oral Propranolol in Children with Infantile Hemangioma

“…Complete regression in superficial types of IH in the present study was 100% at end of 4 months of treatment of combined therapy. These results are much higher than that of other study which used only topical timolol for the same period where complete regression was only 11.88% [6].…”

“…These results were higher than a similar study done in China which, followed VAS and use timolol alone. The regression rate in the Chinese study was 56.4% and the efficacy rate was 92.1% despite the frequency of application was three times daily [6] instead of twice application which was used in the present study.…”

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

“…As shown in the results, age at treatment initiation was closely associated with therapeutic efficacy in both groups, with a higher regression rate for patients younger than 6 months old treated with either topical timolol or oral propranolol. These results were consistent with previous studies, which disclosed that better regression rate of IH lesions could be achieved in patients younger than 6 months old (10, 24). We hypothesized that this phenomenon was due to the characteristic growth behavior of IHs.…”

Propranolol for infantile hemangioma: Evaluating efficacy and predictors of response and rebound growth

“…We found that initiating propranolol before 6 months of age was an independently significant predictor of an excellent response to treatment. The latter accords with the observations of other studies depicting a higher regression rate of IH lesions when β‐blockers are commenced earlier than the age of 6 months 23‐25 . This finding stems from the interplay between the characteristic growth pattern of IH and the effect exerted by propranolol on IH endothelial cells.…”

Clinical Evaluation of Efficacy and Safety of Combined Topical Timolol and Oral Propranolol in Children with Infantile Hemangioma

“…Complete regression in superficial types of IH in the present study was 100% at end of 4 months of treatment of combined therapy. These results are much higher than that of other study which used only topical timolol for the same period where complete regression was only 11.88% [6].…”

“…These results were higher than a similar study done in China which, followed VAS and use timolol alone. The regression rate in the Chinese study was 56.4% and the efficacy rate was 92.1% despite the frequency of application was three times daily [6] instead of twice application which was used in the present study.…”

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

“…As shown in the results, age at treatment initiation was closely associated with therapeutic efficacy in both groups, with a higher regression rate for patients younger than 6 months old treated with either topical timolol or oral propranolol. These results were consistent with previous studies, which disclosed that better regression rate of IH lesions could be achieved in patients younger than 6 months old (10, 24). We hypothesized that this phenomenon was due to the characteristic growth behavior of IHs.…”

Propranolol for infantile hemangioma: Evaluating efficacy and predictors of response and rebound growth

“…We found that initiating propranolol before 6 months of age was an independently significant predictor of an excellent response to treatment. The latter accords with the observations of other studies depicting a higher regression rate of IH lesions when β‐blockers are commenced earlier than the age of 6 months 23‐25 . This finding stems from the interplay between the characteristic growth pattern of IH and the effect exerted by propranolol on IH endothelial cells.…”

Clinical Evaluation of Efficacy and Safety of Combined Topical Timolol and Oral Propranolol in Children with Infantile Hemangioma

“…Complete regression in superficial types of IH in the present study was 100% at end of 4 months of treatment of combined therapy. These results are much higher than that of other study which used only topical timolol for the same period where complete regression was only 11.88% [6].…”

“…These results were higher than a similar study done in China which, followed VAS and use timolol alone. The regression rate in the Chinese study was 56.4% and the efficacy rate was 92.1% despite the frequency of application was three times daily [6] instead of twice application which was used in the present study.…”