Pulsed dye laser and topical timolol gel versus Pulse dye laser in treatment of infantile hemangioma: A double-blind randomized controlled trial

Abstract

Background:Infantile hemangioma (IH) is the most common tumor during infancy that usually appears as macular and gradually becomes a plaque or tumor. Approximately, 20% of all IH cases results in adverse effects and the Pulsed dye laser (PDL) 585 nm is a vascular laser leading to selective the micro vascular damage. Results of studies on non-selective B-blockers (e.g., timolol) indicate their effectiveness in preventing hemangioma growth. The aim of this study is a comparison of PDL plus timolol and PDL in the treatment of IH.Materials and Methods:This double-blind study was carried out on 30 infants (1-12 months old) and the patients were divided into two groups. Group A was treated with the four sessions PDL and the timolol gel 0.05% and Group B with PDL.Results:There were no differences in the mean age of patients for the diagnosis of hemangioma (Group A: 32.69 ± 24.64 days, Group B: 25.69 ± 21.16 days, P = 0.39) and the mean age at the start of the treatment (Group A: 148.125 ± 85.88 days, Group B: 146.25 ± 60.87 days, P = 0.94). There were a statistical difference in the mean of lesion size reduction (Group A: 17.62 ± 6.97 cm and Group B: 12 ± 5.71 cm, P = 0.018), mean percentage change in size mean (Group A: 71079 ± 23.41% and Group B: 54.59 ± 25.46%, P = 0.050) visual analog scale (Group A: 7.19 ± 1.51, Group B: 5.62 ± 1.78, P = 0.012) after treatment. There was no correlation between the time of beginning the treatment and the results (P = 0.857).Conclusions:Application of timolol with PDL is accompanied by the highest efficacy, cost benefits and the short time of treatment.

The Efficacy and Safety of Topical β-Blockers in Treating Infantile Hemangiomas: A Meta-Analysis Including 11 Randomized Controlled Trials

“…Eleven studies enrolling 1,235 infants with hemangiomas that met our inclusion criteria were included in our meta-analysis. Six [8-13] of 11 studies compared the efficacy and safety of a single topical β-blocker with other interventions (such as oral propranolol, placebo, corticosteroids, laser or radiation) in the treatment of SIH, and 5 [14-18] of 11 studies evaluated the efficacy and safety of a topical β-blocker when it was combined with another intervention in treating MIH. A flow diagram that illustrates the search process is shown in Figure 1.…”

“…All studies used clinicians to evaluate the treatment response. Three [8, 14, 15] studies used a visual analog scale to evaluate the therapeutic efficacy in appearance, color and size, and 1 study [11] used clinical photography to document the change in volume. The Achauer grading system was used in 7 studies to assess the reduction in lesion size as poor (0–25%), fair (26–50%), good (51–75%) or excellent (76–100%).…”

“…Similarly, Gong et al [10] discovered that topical timolol maleate together with oral propranolol was safe and effective compared with simple medication. Asilian et al [14] concluded that topical timolol with pulsed dye laser is accompanied by the highest efficacy, cost benefits and a short duration of treatment. For MIH, multiple combined treatments are reported, and the auxiliary role of topical β-blockers is a topic of future research.…”

Intralesional bevacizumab (Avastin®) as a novel addition to infantile hemangioma management: A medical hypothesis

“…To obtain the best treatment outcomes, the treatment protocol should be individualized and comprehensive as well as sequential. [ 1 2 ]…”

“…This may lead to contraindications and development of adverse effects of administrated systemic medications in small or superficial IH. [ 1 4 5 ]…”