Clinical Evaluation of Efficacy and Safety of Combined Topical Timolol and Oral Propranolol in Children with Infantile Hemangioma

Yıl 2018, Cilt: 9 Sayı: 1, 1 - 8, 10.03.2018

Abdulameer Abdulbari Abdulhameed Kalil Esmail Al-hamdi Muntaha Abdulhadi Mathkoor

https://doi.org/10.5799/jcei.413049

Öz

Objective:
To evaluate the
efficacy and safety of combined topical timolol and oral propranolol in
treatment of infantile hemangioma.

Patients
and methods: This
prospective study was conducted in Basra teaching hospital in Basra, Iraq,
where a total of 23 infants with 34 lesions of different types of hemangioma
were included. All lesions were in proliferation phase. The infants’ ages were
less than one year. They were treated with topical timolol solution 0.5%
combined with oral propranolol in a period of 12 weeks (8-16 weeks). The
response to treatment was evaluated clinically by using hemangioma score and
Visual analogue scale. All infants followed 4-12 months after cessation of
drugs.

Results:
By using
hemangioma score system; the combined therapy showed that, 28 (82.4%) lesions
showed excellent response, two (5.9%) showed good response, four (11.8%) showed
fair response and none of the lesions showed poor response at end of 16 weeks.
At the end of 4 months superficial hemangioma showed 100% reduction in their
score, while the ulcerative hemangioma showed 94.7% reduction in their score
while mixed hemangioma showed only 76.7% reduction in their scores. Complete
resolution occurred in 50% of lesions after 4 months of treatment. Neither
included infants developed serious side effects nor, any of the regressed
hemangioma recur during the follow up.

Conclusion:
Combined
topical Timolol 0.5% solution and oral propranolol seems to be a
well-tolerated, safe treatment option with a good to excellent responses. The
most responsive type of hemangioma to this combination are the superficial and
ulcerative types. 

Anahtar Kelimeler

Hemangioma, children, treatment, timolol, propranolol, outcome

Kaynakça

• 1. Haggstrom AN, Garzon MC. Infantile hemangioma. in Dermatology, Editors, Bolognia JL, Jorizzo JL, Shchaffer JV. 3rd ed. Saunders-Elsevier; inc.2012;103,1691-1707.
• 2. James WD, Berger TG, Elston DM. Dermal and Subcutaneous Tumors, in: Andrew Diseases of The Skin Clinical Dermatology. 11th ed. Elsevier Inc. 2011;28.574-619.
• 3. FDA OKs Propranolol Hydrochloride for Infantile Hemangioma. Medscape. Mar 17, 2014 http://www.medscape.com/viewarticle/822115 [accessed at 26/11/2016].
• 4. McMahon P, Oza V, Frieden IJ. Topical timolol for infantile hemangiomas: putting a note of caution in ‘cautiously optimistic’. Pediatr Dermatol 2012;29:127–30.
• 5. Talaal AA, Elbasiouny MS, Elgendy DS, Elwakil TF. Propranolol treatment of infantile hemangioma: clinical and radiological evaluations. J Pediatr Surg 2012;47:707-14.
• 6. Yu L, Li S, Su B, et al Treatment of superficial infantile hemangiomas with timolol: Evaluation of short term efficacy and safety in infants. J Exp Therap Med. 2013;6:2-7.
• 7. Marqueling AL, Oza V, Frieden IJ, Puttgen KB. Propranolol and infantile hemangiomas four years later: a systematic review. Pediatr Dermatol 2013;30:182-91.
• 8. Al-Hamdi K, Zainab Al-Khaledy Z, Al-Amiry A. Clinical evaluation of the oral propranolol efficacy and safety in the treatment of infantile hemangioma. Int J Med Pharm Sci 2015;5:85-98.
• 9. Chamlin SL, Haggstrom AN, Drolet BA, et al. Prospective study of ulcerated hemangiomas. J Pediatr. 2007;151:684–9.
• 10. Sans V, de la Roque ED, Berge J, et al. Propranolol for severe infantile hemangiomas: follow-up report. Pediatrics. 2009;124:e423–31.
• 11. McGee P, Miller S, Black C, Hoey S. Propranolol for infantile hemangioma: A review of current Dosing Regime in a Regional Paediatric Hospital. Ulster Med J 2013:8216-20.
• 12. Michel JL, Patural H. Response to oral propranolol therapy for ulcerated hemangiomas in infancy Arch Pediatr. 2009;16:1565-8.
• 13. Al-Hazim M, Al-Saady SJJ. Topical timolol in treatment of infantile hemangioma, thesis was submitted in partial fulfillment for certification by the Arab Board of medical Specialization in dermatology and venereology 2014.
• 14. Weibel L, Barysch MJ, Scheer HS, et al. Topical Timolol for infantile hemangiomas: Evidence for efficacy and degree of systemic Absorption. Pediatr Dermatol 2016;33:184-90.
• 15. Schupp CJ, Kleber JB. Propranolol therapy in 55 infants with Infantile hemangioma: Dosage, duration, adverse effects, and outcome. Pediatr Dermatol. 2011:28:640-4.
• 16. Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol. 2009;26:610–14.
• 17. Frieden IJ, Drolet BA. Propranolol for infantile hemangiomas: promise, peril, pathogenesis. Pediatr Dermatol. 2009;26:642–4.
• 18. Tan S, Itinteang T, Leadbitter P. Low-dose propranolol for infantile hemangioma. J Plast Reconstr Aesthet Surg 2010;2: 142-6.