Topical Timolol for Small Hemangiomas of Infancy

[Dr.Vad]

Pediatr Dermatol. 2012 Apr 4.
Topical Timolol for Small Hemangiomas of Infancy.
Moehrle M, Léauté-Labrèze C, Schmidt V, Röcken M, Poets CF, Goelz R.

Propranolol has become the treatment of choice of large and complicated infantile hemangiomas. There is a controversy concerning the safety of systemic propranolol. Here we show that topical use of the beta-blocker timolol can also inhibit the growth and promote regression of infantile hemangiomas. In this case series we treated 11 infantile hemangiomas in nine children including six preterm babies with the nonselective betablocker timolol. A timolol containing gel was manufactured from an ophthalmic formulation of timolol 0.5% eyedrops. This gel was applied using a standardized occlusive dressing (Finn-Chambers) containing approximately 0.25 mg of timolol. In all infants topical timolol was associated with growth arrest, a reduction in redness and thickness within the first 2 weeks. Seven hemangiomas showed almost complete resolution, and four became much paler and thinner. No data are available on the transdermal absorption of timolol. Even supposing complete absorption of timolol from the occlusive dressing, a maximum dose of 0.25 mg of timolol would result per day and hemangioma. Regression of infantile hemangiomas treated using 0.5% timolol gel in this case series occurred earlier than spontaneous regression which is generally not observed before the age of 9-12 months. The promising results need to be verified in prospective randomized trials on topical beta blocker administration for infantile hemangiomas which should address dose, duration, and mode of application.

[Dr.Vad]

Topical timolol for infantile hemangioma of the eyelid.
Calvo M, Garcia-Millán C, Villegas C, Fueyo-Casado A, Burón I.
Int J Dermatol. 2012 Mar 14.

Infantile Hemangioma of the Eyelid Treated With Timolol Gel.
Fernández-Ballesteros MD, Vera-Casaño A, Escudero-Gómez J, Hiraldo-Gamero A.
Actas Dermosifiliogr. 2012 Jan 20.

First report of topical timolol treatment in primarily ulcerated perineal haemangioma.
Cante V, Pham-Ledard A, Imbert E, Ezzedine K, Léauté-Labrèze C.
Arch Dis Child Fetal Neonatal Ed. 2012 Mar;97(2):F155-6.

Treatment of small superficial haemangioma with timolol 0.5% ophthalmic solution: a series of 20 cases.
Oranje AP, Janmohamed SR, Madern GC, de Laat PC.
Dermatology. 2011;223(4):330-4.

Timolol maleate 0.5% or 0.1% gel-forming solution for infantile hemangiomas: a retrospective, multicenter, cohort study.
Chakkittakandiyil A, Phillips R, Frieden IJ, Siegfried E, Lara-Corrales I, Lam J, Bergmann J, Bekhor P, Poorsattar S, Pope E.
Pediatr Dermatol. 2012 Jan-Feb;29(1):28-31.

[Iluhin]

Здорово! Спасибо, уважаемый Вадим Валерьевич.

[Dr.Vad]

из свободно доступного:

Topical Timolol for Infantile Hemangiomas: Putting a Note of Caution in “Cautiously Optimistic”
Pediatric Dermatology Vol. 29 No. 1 127–130, 2012

[Ссылки доступны только зарегистрированным пользователям ]

[Dr.Vad]

A retrospective, consecutive, nonrandomized, comparative single-masked cohort study of all patients presenting with nonvision-threatening periocular infantile capillary hemangiomas between August 2007 and January 2011 was performed. Parents chose twice daily topical 0.25% timolol maleate gel or observation. Photographs were taken at all visits and subsequently evaluated by masked examiners for change in lesion size, color, and thickness. Lesions were clinically defined as superficial, mixed, or deep. The primary outcome was response to treatment at 2 months, categorized as good (size decreased >50%), moderate (decrease 0-50%), or poor (enlarged or caused visually significant ptosis or induced astigmatism). The secondary outcome was response at latest follow-up visit.

RESULTS: Thirteen children received timolol, and 10 children were observed, with mean ages at presentation of 4.8 and 3.7 months (p = 0.31), respectively. In the treated group, good response was observed in 8 (61.5%) infants, moderate response was seen in 4 (30.8%), and poor response was seen in one patient (7.7%). In the observed group, 0 (0%) demonstrated good response, one (10%) demonstrated moderate response, and 9 demonstrated poor response (90%) (p < 0.001). Responses were consistent on long-term follow-up (range 3-41 months). Both superficial ( 100% good response) and mixed (43% good, 57% moderate) lesions responded well to timolol; the one deep lesion did not. No adverse ocular or systemic effects were observed.

Ophthal Plast Reconstr Surg. 2012 Mar;28(2):103-6.
A controlled study of topical 0.25% timolol maleate gel for the treatment of cutaneous infantile capillary hemangiomas.
Chambers CB, Katowitz WR, Katowitz JA, Binenbaum G.
SourceDepartment of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.

[Dr.Vad]

J Plast Reconstr Aesthet Surg. 2013 Dec;66(12):1732-40.

Treatment of infantile haemangiomas with atenolol: comparison with a historical propranolol group.
de Graaf M1, Raphael MF, Breugem CC, Knol MJ, Bruijnzeel-Koomen CA, Kon M, Breur JM, Pasmans SG.

Propranolol, a lipophilic non-selective beta-blocker, has proven to be effective in the treatment of infantile haemangioma (IH). However, several side effects have been reported. Atenolol, a hydrophilic selective beta-1 blocker, could be an alternative and associated with fewer side effects. Thirty consecutive patients with IH were treated with atenolol between June 2010 and May 2011. The therapeutic effect was judged by clinical assessment and quantified by using a visual analogue scale (VAS) and the Haemangioma Activity Score (HAS). Side effects were also evaluated. The atenolol cohort was compared with a previously described cohort of 28 patients treated with propranolol between July 2008 and December 2009. Clinical involution was present in 90% (27/30) of the IH patients treated with atenolol. Mild side effects occurred in 40% (12/30) of these patients and severe side effects occurred in 3% (1/30). Compared with the previously described cohort treated with propranolol, mild side effects occurred in 50% (14/28) and severe side effects in 25% (7/28) of the patients (p=0.04). Quantitative improvement of the IH in the atenolol group (n=27) showed no significant difference in either the VAS score or the HAS compared to the propranolol group (n=24). This study indicates that atenolol is effective in the treatment of IH. Compared with a historical control group treated with propranolol, the effects of atenolol seem to be similar and less frequently associated with severe side effects. Randomised clinical trials are necessary to evaluate the efficacy and safety of atenolol treatment in IH.