Dramatic response to topical timolol lotion of a large hemifacial infantile haemangioma associated with PHACE syndrome

Khunger, Niti; Pahwa, Manish

doi:10.1111/j.1365-2133.2010.10177.x

Cited by 56 publications

(49 citation statements)

References 11 publications

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“…In the meantime, additional studies have been reported on this aspect [15,16,17]. Recently, Bonifazi et al [15] reported promising results with topical propranolol in a 1% cream in 23 cases of superficial HOI.…”

Section: Introductionmentioning

confidence: 90%

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Treatment of Small Superficial Haemangioma with Timolol 0.5% Ophthalmic Solution: A Series of 20 Cases

Oranje

Janmohamed

Madern³

et al. 2011

Dermatology

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Background: Haemangioma of infancy (HOI) on the face may be disfiguring and alarming for parents. Usually they are not treated when they are small. Treatment of HOI with propranolol is a breakthrough. Timolol (topical treatment) and propranolol are closely related. Methods: We considered topical treatment with timolol 0.5% ophthalmic solution 3–4 times daily in patients with small HOI. Twenty patients with small mostly superficial HOI were included. Results: A series of 20 patients with HOI treated with timolol 0.5% ophthalmic solution are described. The treatment was effective in all superficial HOIs after 1–4 months. A quick direct inhibitory effect on the growth of the HOI followed by slower regression was observed. The children had to be treated during the whole proliferative phase. Deep HOIs on the nose (2 cases) and lower eyelid (1 case) showed no response. Conclusion: Topical timolol 0.5% ophthalmic solution is effective in HOI. Safety and effectiveness of drugs like topical timolol and topical propranolol require further investigation but they seem very safe when used in small HOIs. We recommend that small superficial HOIs should be treated in an early proliferative phase.

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Section: Introductionmentioning

confidence: 90%

“…Ni et al [16] published more data on the use of topical timolol for periocular HOI. Khunger and Pahwa [17 ]published positive results in a large flat HOI in PHACE syndrome.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Small Superficial Haemangioma with Timolol 0.5% Ophthalmic Solution: A Series of 20 Cases

Oranje

Janmohamed

Madern³

et al. 2011

Dermatology

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“…Adverse reactions due to topical corticosteroids for IH have been reported by Pandey et al [8] . The topical use of β-blockers for IH was mostly safe; however, there were reports of sleep disturbance [17] and mild pruritus [20] . Our 6-year study of IH treatment in a tertiary referral hospital supports the safety and effectiveness of 0.5% timolol maleate solution and gel compared with topical ultrapotent corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Topical Timolol Maleate 0.5% for Infantile Hemangioma: Its Effectiveness Compared to Ultrapotent Topical Corticosteroids - A Single-Center Experience of 278 Cases

et al. 2016

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Background: Infantile hemangioma (IH) may have implications on parental distress and cosmetic disfigurement. To date, ultrapotent corticosteroids are used as a treatment of choice for superficial IH. However, due to their side effects and sometimes lack of IH regression, it is necessary to find alternative topical therapies. Timolol maleate 0.5% solution and gel are nonselective β-blockers that could inhibit proliferation and trigger regression of IH. Objective: To evaluate the efficacy of topical ultrapotent corticosteroids and timolol maleate 0.5% solution and gel for superficial IH. Patients and Methods: The study design was prospective. Two hundred and seventy-eight patients diagnosed as having superficial IH were enrolled from the outpatient clinic of the Department of Dermatology and Venereology, Dr. Sardjito Hospital, Yogyakarta, Indonesia, from January 2009 to December 2014. Patients were divided into three groups: A = treated with topical ultrapotent corticosteroid, B = timolol maleate 0.5% solution and C = timolol maleate 0.5% gel. Patients were followed for 6 months to evaluate the lesion. Lesion size was measured from scaled photodocumentation with the software program ImageJ®. Results: There were significant differences in IH size after treatment with timolol maleate 0.5% solution compared with ultrapotent corticosteroids (p < 0.001) and timolol maleate 0.5% gel compared with ultrapotent corticosteroids (p < 0.001). There was no significant difference in IH lesions after treatment with timolol maleate 0.5% solution versus gel (p = 0.744). Conclusion: Timolol maleate 0.5% solution and gel were significantly superior to topical ultrapotent corticosteroids in size reduction of superficial IH.

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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%

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

Chan¹,

McKay²,

Adams

et al. 2013

Pediatrics

133

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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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Dramatic response to topical timolol lotion of a large hemifacial infantile haemangioma associated with PHACE syndrome

Cited by 56 publications

References 11 publications

Treatment of Small Superficial Haemangioma with Timolol 0.5% Ophthalmic Solution: A Series of 20 Cases

Treatment of Small Superficial Haemangioma with Timolol 0.5% Ophthalmic Solution: A Series of 20 Cases

Topical Timolol Maleate 0.5% for Infantile Hemangioma: Its Effectiveness Compared to Ultrapotent Topical Corticosteroids - A Single-Center Experience of 278 Cases

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

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