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

Abstract

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.

Comparison of Two Formulations of Topical Timolol for the Treatment of Infantile Hemangiomas

“…The efficacy of TXE treatment was largely similar to that of TM treatment for superficial lesions (57.7% vs 56.3% good response; p = 0.21) and mixed lesions (53.8% vs 40% good response; p = 0.35). This agrees with earlier findings of Danarti et al , who concluded that TM and TXE treatment had similar therapeutic efficacy for superficial IH lesions. Earlier age of treatment initiation was associated with better therapeutic response (62.8% good response with treatment initiation <3 mos vs 35.3% with treatment initiation >6 mos; p = 0.18).…”

Prospective, open‐label, rater‐blinded and self‐controlled pilot study of the treatment of proliferating superficial infantile hemangiomas with 0.5% topical timolol cream versus 595‐nm pulsed dye laser

“…6 In addition to the significant efficacy of topical timolol observed in our center, 4 several other reports support this observation. Oral propranolol, a beta-blocker, may cause systematic adverse events and therefore close monitoring of the patients is required.…”

“…Compared with other topical medication, timolol maleate is considerably superior to topical corticosteroids, regardless of its form, whether in solution or gel. 6 In addition to the significant efficacy of topical timolol observed in our center, 4 several other reports support this observation. One multicenter retrospective cohort study revealed that among all the 731 patients treated with topical timolol, the best response occurred in superficial IH of less than 1-mm thickness, and adverse events were noted only in 3.4% of the patients.…”

Topical Application of 0.5% Timolol Maleate Hydrogel for the Treatment of Superficial Infantile Hemangioma

“…In a retrospective study by Qiu et al, timolol 0.5% eye drop and imiquimod 5% cream achieved equivalent clinical efficacy, but fewer side effects were observed in patients treating with topical timolol (16). Danarti et al compared the effectiveness of topical corticosteroids and timolol maleate 0.5% solution or gel (21). Effectiveness of topical timolol maleate 0.5% solution or gel was significantly better than topical corticosteroids, but there was no difference in IHs treating with timolol solution versus gel (21).…”

“…Danarti et al compared the effectiveness of topical corticosteroids and timolol maleate 0.5% solution or gel (21). Effectiveness of topical timolol maleate 0.5% solution or gel was significantly better than topical corticosteroids, but there was no difference in IHs treating with timolol solution versus gel (21). A cohort study showed that timolol 0.5% gel forming solution was more effective than timolol 0.1% gel forming solution, suggesting that drug concentration is an important predictor for clinical responses (22).…”