The effectiveness and safety of topical β‐receptor blocker in treating superficial infantile haemangiomas: A meta‐analysis including 20 studies

Lin, Zhenying; Zhang, Baoxin; Yu, Zhongjing; Li, Huanyuan

doi:10.1111/bcp.14196

Cited by 28 publications

(36 citation statements)

References 27 publications

(57 reference statements)

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“…Several reports have described similar outcomes using topical beta-blockers for the treatment of superficial periocular IH and two large recent meta-analyses, involving 1235 and 2098 children, concluded that topical beta-blockers may replace oral propranolol as first-line treatment for superficial IH due to its comparable effectiveness and reduced adverse effects [8,9].…”

Section: Discussionmentioning

confidence: 90%

Topical Timolol for Infantile Haemangioma of the Orbit

Hildebrand

Sipkova

2021

Klin Monbl Augenheilkd

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Infantile haemangiomas (IHs) are the most common benign tumours of the eyelid and orbits in infancy. Beta-blockers, in the form of oral propranolol, have become first-line treatment in severe cases with functionally significant or disfiguring IH. However, adverse drug reactions of oral propranolol in infants are reported in 1 in 11 and serious or potentially life-threatening systemic side effects in 1 in 38, including dyspnoea, hypotension, hyperkalaemia, hypoglycaemia, and cyanosis, therefore requiring careful and close monitoring during the course of systemic treatment. More recently, two large meta-analyses have shown topical beta-blockers, such as timolol maleate 0.5%, to be as effective as oral propranolol in superficial IH, but with no or significantly fewer adverse effects, and have advocated that topical beta-blockers replace oral propranolol as the first-line treatment of superficial IH. We have previously reported the therapeutic response of deep periocular IH to primary topical timolol maleate 0.5% monotherapy. Here we also describe the first successful treatments of large orbital IHs with primary topical timolol maleate 0.5% monotherapy in four infants, resulting in immediate cessation of progression and rapid clinical improvement or resolution in all cases. No adverse effects and no recurrence during long-term follow-up of up to 2.5 years after cessation were seen in any of the patients treated with topical timolol maleate 0.5%.

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Section: Discussionmentioning

confidence: 90%

Topical Timolol for Infantile Haemangioma of the Orbit

Hildebrand

Sipkova

2021

Klin Monbl Augenheilkd

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“…However, since 0.5% topical timolol appears to be the most widely used formulation, 2 , 7 , 8 a meta‐analysis conducted by Ng et al in 2016, focused more extensively on the therapeutic protocols rather than on the concentrations, showing that encouraging results are indeed possible with different 0.5% topical timolol administration protocols (1 drop BID, 2 drops BID, 3 drops TID/QID, 3 drops TID), as Global Assessment Score greater than 3 (which indicates an acceptable clinical improvement) was registered in 47% up to 88% of cases. 9 …”

Section: Beta‐blockers In Infantile Hemangioma Treatmentmentioning

confidence: 99%

Topicalbeta‐blockersin dermatologic therapy

Filoni

Ambrogio

Marco

et al. 2021

Dermatologic Therapy

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An increasing use of beta-blockers in dermatology has been described over the last 10 years, despite the fact that their use in diseases other than infantile hemangiomas is off-label. This review discusses the emerging role of topical beta-blockers in the treatment of infantile hemangioma, but also pyogenic granuloma, Kaposi sarcoma, wounds and nail paronychia. Data in literature demonstrate that topical beta-blockers are a safe and valid therapeutic option in numerous cutaneous diseases. Side effects are mainly restricted to the application site. Further studies and randomized trials may contribute to reinforce the role of topical beta-blockers in the dermatological armamentarium.

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“… 6 To date, there is an appreciable number of studies that support the efficacy and safety of TTM in term infants with IHs. 70 – 76 A meta-analysis in 2020 showed that TTM is likely non-inferior to oral propranolol (OR 0.955, 95% CI 0.700–1.302, p =0.769) in treating superficial IHs. In addition, it was superior to topical imiquimod (OR 2.561, 95% CI 1.182–5.550, p =0.017) and conservative management (OR 18.458, 95% CI 5.660–60.191, p <0.001).…”

Section: Reviewmentioning

confidence: 99%

“…Some examples of adverse reactions include desquamation, nocturnal crying, erythema and diarrhoea, all of which occurred in around 1% of cases. 76 According to Drolet et al, one drop of 0.5% TTM twice daily has the potential of reaching a plasma concentration known to have systemic beta-blocking activity in adults, especially with increasing IH thickness. In thick IHs, doses exceeding two drops of 0.5% TTM per day are not recommended and may not have the safety advantage over oral beta-blockers.…”

Section: Reviewmentioning

confidence: 99%

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Paediatrics: how to manage infantile haemangioma

Kim¹,

Lam²

2021

DIC

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Infantile haemangiomas (IHs) are relatively common benign vascular tumours found in the paediatric population. They have varying sizes and involve different depths in the skin leading to various colours, shapes and textures. Although considered harmless in most cases, they may lead to life-threatening complications or cause permanent disfigurations and organ dysfunction. For problematic IHs, the treatment options include oral and topical beta-blockers, systemic corticosteroids, laser treatment, and surgery. In this narrative review, the treatment options for problematic IH are compared and delivered concisely to facilitate the clinical decisions from practitioners, including those in primary care settings. Oral propranolol is currently considered the first-line intervention for problematic IHs. For superficial lesions, there is robust evidence for the use of topical timolol maleate. Systemic corticosteroids are sometimes used in specific situations such as resistance or contraindications to beta-blockers. Surgical excision can be considered in cases requiring urgent intervention such as airway obstruction; this can be done alongside laser therapies for the removal of residual tissue or when reconstructing areas of deformity. The combination of multiple treatment modalities may lead to a more rapid clinical response.

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The effectiveness and safety of topical β‐receptor blocker in treating superficial infantile haemangiomas: A meta‐analysis including 20 studies

Cited by 28 publications

References 27 publications

Topical Timolol for Infantile Haemangioma of the Orbit

Topical Timolol for Infantile Haemangioma of the Orbit

Topicalbeta‐blockersin dermatologic therapy

Paediatrics: how to manage infantile haemangioma

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