Comparison of the Effectiveness of Topical and Oral Beta Blockers in the Treatment of Childhood Hemangiomas

Year 2023, , 309 - 314, 20.12.2023

Kerim Faruk Yüksel , Yaşar Kandur , Ayşegül Alpcan , Serkan Tursun , Sevde Nur Vural , Meryem Albayrak

https://doi.org/10.46332/aemj.1133840

Abstract

Purpose: Hemangiomas are the most common vascular tumors in childhood, and the treatment options have undergone profound changes in recent years. In this study, we aimed to compare the efficacy and safety of beta-blockers on hemangiomas, both topi-cal and oral, with non-pharmacological treatment in the pediatric age group.

Material and Methods: We retrospectively reviewed the medical records of pediatric patients with hemangiomas.

Results: Fifty-three patients (F/M=40/13) were enrolled in this study. Superficial hemangiomas were detected in 14 (26.4%) patients, and deep hemangiomas were detected in 39 (73.6%) patients. Seventeen patients were followed without medication, 19 were treated with a topical beta blocker, and 17 were treated with an oral beta blocker. Twelve patients with superficial hemangi-omas were followed without medication, while two received topical timolol treatment. A comparison of lesion progression in patients with superficial hemangiomas in the non-pharmacological treatment and topical treatment groups showed that the mean scores of success, in terms of mean fading and reduction in lesion depth, were significantly higher at the first month (7.0 vs. 1.66; p=0.049; 6.0 vs. 1.5; p=0.045). Among patients with deep hemangiomas, a comparison of mean fading scores showed no difference between the oral and topical treatment groups in the first and fourth months (p=0.551, p=0.551).

Conclusion: We believe that oral beta-blockers can be used instead of topical treatment in the future, and they will be preferred more by clinicians and families due to less side effects.

Keywords

beta blocker, deep, hemangioma, superficial topical

Çocukluk Çağı Hemanjiomlarının Tedavisinde Topikal ve Oral Beta-blokerlerin Etkinliğinin Karşılaştırılması

Abstract

Amaç: Hemanjiomlar çocukluk çağında en sık görülen vasküler tümörlerdir ve tedavi yaklaşımları son yıllarda köklü değişiklik-lere uğramıştır. Bu çalışma ile pediatrik yaş grubunda, beta blokerlerin topikal ve oral olmak üzere hemanjiyomlar üzerine etkinli-ği ve güvenilirliğini nonfarmakolojik tedavi ile karşılaştırmayı amaçladık.

Araçlar ve Yöntem: Hemanjiomlu çocuk hastalara ait tıbbi kayıtlar retrospektif olarak incelendi.

Bulgular: Çalışmaya elli üç hasta (K/E=40/13) dahil edildi. Hastaların 14'ünde (%26.4) yüzeyel hemanjiom, 39'unda (%73.6) derin hemanjiom saptandı. On yedi hasta ilaçsız izlendi, 19 hasta topikal beta bloker ve 17 hasta oral beta bloker ile tedavi edildi. Yüzeyel hemanjiomlu 12 hasta ilaçsız izlendi, 2 hasta topikal timolol tedavisi gördü.
Yüzeysel hemanjiyomlarda ilaçsız izleme göre topikal timololün iyileşme puanlarının daha yüksek olduğu ve ortalama solma ve lezyon derinliğinde azalmanın daha belirgin olduğu saptandı. (7.0'a karşı 1.66; p= 0.049; 6.0'a karşı 1.5; p=0.045).
Derin hemanjiyomlu hastalar oral ve topikal tedavi açısından karşılaştırıldığında, ortalama solma skorlarının hem 1. hem de 4. ayda grupları arasında fark göstermediği görüldü (p=0.551, p=0.551).

Sonuç: Gelecekte topikal tedavi yerine oral beta blokerlerin kullanılabileceği ve klinisyenler ve aileler tarafından daha az yan etkisi nedeniyle daha fazla tercih edileceğine inanıyoruz.

Keywords

yüzeyel, derin, hemanjiom, beta bloker, topikal

References

• 1. Smith CJF, Friedlander SF, Guma M, Kavanaugh A, Chambers CD. Infantile hemangiomas: an updated review on risk factors, pathogenesis, and treatment. Birth Defects Res. 2017;109(11):809-815.
• 2. Wassef M, Blei F, Adams D, et al. Vascular anomalies classification: recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics. 2015;136(1):e203-e214.
• 3. Léauté-Labrèze C, De La Roque ED, Hubiche T, Boralevi F, Thambo J-B, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358 (24):2649-2651.
• 4. Guo S, Ni N. Topical treatment for capillary hemangioma of the eyelid using β-blocker solution. Arch Ophthalmol. 2010;128(2):255-256.
• 5. Wu HW, Wang X, Zhang L, Zheng JW, Liu C, Wang YA. Topical Timolol vs. Oral Propranolol for the Treatment of Superficial Infantile Hemangiomas. Frontiers in oncology. 2018;8:605.
• 6. Khan M, Boyce A, Prieto-Merino D, Svensson Å, Wedgeworth E, Flohr C. The role of topical timolol in the treatment of infantile hemangiomas: a systematic review and meta-analysis. Acta Derm Venereol. 2017;97(10):1167-1171.
• 7. Drolet BA, Frommelt PC, Chamlin SL, et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics. 2013;131 (1):128-140.
• 8. Li J, Chen X, Zhao S, et al. Demographic and clinical characteristics and risk factors for infantile hemangioma: a Chinese case-control study. Arch Dermatol. 2011;147(9):1049-1056.
• 9. Amir J, Metzker A, Krikler R, Reisner S. Strawberry hemangioma in preterm infants. Pediatr Dermatol. 1986;3(4):331-332.
• 10. Léauté Labrèze C, Prey S, Ezzedine K. Infantile haemangioma: part I. Pathophysiology, epidemiology, clinical features, life cycle and associated structural abnormalities. J Eur Acad Dermatol Venereol. 2011;25 (11):1245-1253.
• 11. Xu P, Yu Q, Huang H, Zhang W, Li W. A self controlled study of intralesional injection of diprospan combined with topical timolol cream for treatment of thick superficial infantile hemangiomas. Dermatol Ther. 2018;31(3):e12595.
• 12. Wang L, Xia Y, Zhai Y, Li C, Li Y. Topical propranolol hydrochloride gel for superficial infantile hemangiomas. J Huazhong Univ Sci Technolog Med Sci. 2012;32(6):923-926.
• 13. Chakkittakandiyil A, Phillips R, Frieden IJ, et al. Timolol maleate 0.5% or 0.1% gel forming solution for infantile hemangiomas: a retrospective, multicenter, cohort study. Pediatr Dermatol. 2012;29(1):28-31.
• 14. Chan H, McKay C, Adams S, Wargon O. RCT of timolol maleate gel for superficial infantile hemangiomas in 5-to 24-week-olds. Pediatrics. 2013;131 (6):e1739-e747.
• 15. Yu L, Li S, Su B, et al. Treatment of superficial infantile hemangiomas with timolol: Evaluation of short-term efficacy and safety in infants. Exp Ther Med. 2013;6(2):388-390.
• 16. Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015;372 (8):735-746.
• 17. Kaneko T, Sasaki S, Baba N, et al. Efficacy and safety of oral propranolol for infantile hemangioma in Japan. Pediatr Int. 2017;59(8):869-877.
• 18. Sans V, de la Roque ED, Berge J, et al. Propranolol for severe infantile hemangiomas: follow-up report. Pediatrics. 2009;124(3):e423-e431.
• 19. Erbay A, Sarialioglu F, Malbora B, et al. Propranolol for infantile hemangiomas: a preliminary report on efficacy and safety in very low birth weight infants. Turk J Pediatr. 2010;52(5):450.
• 20. Manunza F, Syed S, Laguda B, et al. Propranolol for complicated infantile haemangiomas: a case series of 30 infants. Br J Dermatol. 2010;162(2):466-468.