Review of topical beta blockers as treatment for infantile hemangiomas

Painter, Sally; Hildebrand, Göran Darius

doi:10.1016/j.survophthal.2015.08.006

Cited by 48 publications

(50 citation statements)

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“…MRI of the orbits was in keeping with an infantile hemangioma. An initial trial of topical timolol maleate 0.5%, applied by rubbing 3 drops twice daily into the skin overlying the lesion, was commenced, as described previously [4,5,6], but no significant effect was seen after a week. Therefore, an urgent diagnostic orbital biopsy was performed (Fig.…”

Section: Case Reportmentioning

confidence: 99%

“…The clinical use of β-antagonists either orally or topically has been shown to be efficacious in inducing regression of IH [3,4,5,6]. Topical timolol maleate, a nonselective β-antagonist with a lipophilic moiety that enhances transdermal absorption, induces regression of periocular IH with minimal side effects [3,4,5,6]. It is increasingly considered an alternative option to oral propanolol not only for superficial, but also deep periocular IHs [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

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Early and Late Histological and Ultrastructural Findings in Resected Infantile Capillary Hemangiomas Following Treatment with Topical Beta-Blocker Timolol Maleate 0.5%

et al. 2017

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Background: Infantile capillary hemangiomas (IHs) affect approximately 4-5% of infants. The systemic nonselective β-adrenergic antagonist, propranolol, has become the standard first-line treatment for severe IHs. The topical β-antagonist, timolol maleate, has also demonstrated efficacy and safety in treating superficial and some deep capillary hemangiomas. Despite their therapeutic success and prevalent use, the mechanism of action of β-adrenergic antagonists in the treatment of IHs is not well understood. Methods: Histopathological and electron microscopic evaluation of two periocular IHs excised at 1 week and 24 months following topical timolol treatment was performed. Results: Distinct morphological differences were observed between spontaneously regressed and β-antagonist-treated IHs. The former was characterized by diffuse collagen deposition and interstitial fibrosis, while the latter showed organized concentric collagen IV deposition within obliterated vessel lumen, suggestive of waves of endothelial cell apoptosis, leaving behind layers of basement membrane deposits as a stress response. Conclusions: Based on these observations, we hypothesize that, apart from their well-known cardiac and vasodilatory effects, β-antagonists could induce endothelial cell apoptosis in IH leading to endovascular occlusion and we present supporting evidence to explain why this response might be specific to hypoxic tissue.

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Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early and Late Histological and Ultrastructural Findings in Resected Infantile Capillary Hemangiomas Following Treatment with Topical Beta-Blocker Timolol Maleate 0.5%

et al. 2017

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“…As the lesions may be a significant source of parental distress, cosmetic disfigurement, and morbidity, appropriate management and optimizing patient outcomes are needed [4,5] .…”

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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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“…When initiated in the proliferative phase of the lesion, the effectiveness of the treatment can be seen within days [16].…”

Section: Topicalmentioning

confidence: 99%

Burn Hemangioma (BH) (Scalded Pyogenic Granuloma) versus Infantile Hemangioma: Report of Six Cases of BH and Its Effective Therapy with Oral Propranolol

Sharquie¹,

Noaimi²,

Radhi³

2017

JCDSA

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Infantile hemangioma and burn hemangioma have many similarities in clinical pictures, pathology and treatment. As infantile hemangioma appears usually after birth and then rapidly grow within few months and then a statue state and then involutes within few years while burn hemangioma so called burn pyogenic granuloma usually appears within days after burn with liquid and grow rapidly into many giant angiomatous masses and then after short time usually weeks or months will involute in more than 37.5% of cases.

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Review of topical beta blockers as treatment for infantile hemangiomas

Cited by 48 publications

References 47 publications

Early and Late Histological and Ultrastructural Findings in Resected Infantile Capillary Hemangiomas Following Treatment with Topical Beta-Blocker Timolol Maleate 0.5%

Early and Late Histological and Ultrastructural Findings in Resected Infantile Capillary Hemangiomas Following Treatment with Topical Beta-Blocker Timolol Maleate 0.5%

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

Burn Hemangioma (BH) (Scalded Pyogenic Granuloma) versus Infantile Hemangioma: Report of Six Cases of BH and Its Effective Therapy with Oral Propranolol

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