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Abstract
INTRODUCTION Beta-blocker (Propanolol or Timolol maleate) treatment of infantile hemangiomas (IH) is a safe and effective treatment in the outpatient setting. The authors report a single surgeon's initial experience with setting up an outpatient service of beta-blocker treatment for head and neck IH at a tertiary children's hospital. METHODS A prospective study of children with head and neck IHs commenced in January 2015 with the end point being December 2018. Each child started either oral propranolol (2 mg/kg/day) or topical Timolol 0.5%. RESULTS Thirty-eight patients commenced a beta-blocker during the study duration. The mean age at time of starting therapy was 9 months (range 3 weeks to 116 months). Four patients were older than 12 months at commencement. The mean duration of treatment was 9 months. The response to treatment was excellent or complete in 29% (n = 11), good in 50% (n = 18) and mild in 10% (n = 4). The non response rate was 10% (n = 4). No major adverse effects occurred but 29% (n = 11) experienced minor side effects. CONCLUSION Low dose propranolol and topical Timolol is been safe and easy to use for surgeons who may not be regular prescribers or unfamiliar with treating children with IHs with beta-blocker therapy. In patient monitoring is unnecessary and parents can be taught easily to recognise side effects. Treating children from the start builds a trusting relationship with the family before the child requesting cosmetic revision of the fibro-fatty remnant.
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Sun L, Wang C, Cao Y, Lv X, Tian L, Liu D, Li L, Zhao W. Fractional 2940-nm Er:YAG laser-assisted drug delivery of timolol maleate for the treatment of deep infantile hemangioma. J DERMATOL TREAT 2020; 32:1053-1059. [PMID: 32043380 DOI: 10.1080/09546634.2020.1729330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Li Sun
- Department of Dermatology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Chenxia Wang
- Department of Dermatology, Yulin No. 2 Hospital, Yulin, China
| | - Yuting Cao
- Department of Dermatology, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Xinxiang Lv
- Department of Dermatology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Limin Tian
- Department of Dermatology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Dandan Liu
- Department of Dermatology, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot, China
| | - Lizhong Li
- Maternal and Child Health Care and Family Planning Service Center, Hohhot, China
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Püttgen K, Lucky A, Adams D, Pope E, McCuaig C, Powell J, Feigenbaum D, Savva Y, Baselga E, Holland K, Drolet B, Siegel D, Morel KD, Garzon MC, Mathes E, Lauren C, Nopper A, Horii K, Newell B, Song W, Frieden I. Topical Timolol Maleate Treatment of Infantile Hemangiomas. Pediatrics 2016; 138:peds.2016-0355. [PMID: 27527799 DOI: 10.1542/peds.2016-0355] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There has been a dramatic increase in the off-label use of ophthalmic timolol maleate, a β-blocker used for infantile hemangioma (IH) treatment as a topical counterpart to oral propranolol. Its safety and efficacy in a pediatric population with IH have not been evaluated in a large cohort. Our goal was to retrospectively assess timolol's effectiveness, discern characteristics associated with response, and document reported adverse events. METHODS A multicenter retrospective cohort study of 731 patients treated with topical timolol was completed at 9 centers. Inclusion required an IH suitable for timolol in the treating physician's judgment and access to clinical details including photographs. Logistic regression analysis and descriptive statistics were performed. Primary outcome measures were efficacy assessed by using visual analog scales for color and for size, extent, and volume from review of digital photographs taken as standard of care. RESULTS Most IHs were localized (80.1%) and superficial (55.3%). Risk of disfigurement was the most common indication for therapy (74.3%). Duration of therapy (P < .0001), initial thinness (P = .008), and subtype (P = .031) were significant predictors of response. Best response occurred in superficial IHs <1 mm thick. Fifty-three (7.3%) required subsequent therapy with systemic β-blocker. Adverse events were mild, occurring in 25 (3.4%) patients. No cardiovascular side effects were documented. CONCLUSIONS Timolol seems to be a well-tolerated, safe treatment option with moderate to good effectiveness, demonstrating best response in thin, superficial IHs regardless of pretreatment size. Timolol can be recommended as an alternative to systemic β-blockers and watchful waiting for many patients.
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Affiliation(s)
| | - Anne Lucky
- Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Denise Adams
- Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Elena Pope
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Julie Powell
- Sainte-Justine Hospital, Montréal, Québec, Canada
| | - Dana Feigenbaum
- University of California, San Francisco, San Francisco, California
| | - Yulia Savva
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Beth Drolet
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dawn Siegel
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Erin Mathes
- University of California, San Francisco, San Francisco, California
| | | | - Amy Nopper
- Children's Mercy Hospital, Kansas City, Missouri; and
| | | | | | - Wei Song
- Children's Hospital of Fudan University, Shanghai, China
| | - Ilona Frieden
- University of California, San Francisco, San Francisco, California
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Zhang Q, Chantasart D, Kevin Li S. Evaluation of β-blocker Gel and Effect of Dosing Volume for Topical Delivery. J Pharm Sci 2015; 104:1721-31. [DOI: 10.1002/jps.24390] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/13/2015] [Accepted: 01/20/2015] [Indexed: 01/09/2023]
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Qiu Y, Yang J, Chen M, Chang L, Wang T, Ma G, Jin Y, Chen H, Lin X. A prospective self-controlled study of topical timolol 0.5% cream for large superficial infantile hemangiomas. J Dermatol 2015; 42:363-6. [PMID: 25656976 DOI: 10.1111/1346-8138.12786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/21/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Yajing Qiu
- Department of Plastic and Reconstructive Surgery; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Jingyan Yang
- Department of Epidemiology; Mailman School of Public Health; Columbia University; New York USA
| | - Minyan Chen
- Department of Pharmacy; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Lei Chang
- Department of Plastic and Reconstructive Surgery; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Tianyou Wang
- Department of Plastic and Reconstructive Surgery; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Gang Ma
- Department of Plastic and Reconstructive Surgery; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Yunbo Jin
- Department of Plastic and Reconstructive Surgery; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery; Shanghai Ninth People's Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
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Bota M, Popa G, Blag C, Tataru A. Infantile Hemangioma: A Brief Review. ACTA ACUST UNITED AC 2015; 88:23-7. [PMID: 26528043 PMCID: PMC4508608 DOI: 10.15386/cjmed-381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/29/2014] [Indexed: 12/13/2022]
Abstract
Infantile hemangiomas as frequent infancy tumors have been a controversial issue of medical scientists worldwide. Their clinical aspects are various and their physiopathology is yet to be fully understood. Numerous publications outline the characteristics, causes, evolution possibilities and therapeutic approaches. Deciding whether to treat or not is the main question of this kind of pathology. Hemangiomas that have complications or can cause irreversible damage need therapy. This is a brief review of up-to-date information regarding the presentation of infantile hemangiomas and target-therapies.
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Affiliation(s)
- Madalina Bota
- Department of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gheorghe Popa
- Department of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Blag
- Department of Pediatrics II, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandru Tataru
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Epperla N, Brilliant MH, Vidaillet H. Topical timolol for treatment of epistaxis in hereditary haemorrhagic telangiectasia associated with bradycardia: a look at CYP2D6 metabolising variants. BMJ Case Rep 2014; 2014:bcr-2013-203056. [PMID: 24518395 DOI: 10.1136/bcr-2013-203056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 59-year-old man presented to the emergency department with lightheadedness. He had started intranasal administration of ophthalmic timolol for the prevention of epistaxis associated with hereditary haemorrhagic telangiectasia approximately 3 weeks earlier with excellent response. His heart rate was about half its normal rate, an ECG revealed sinus bradycardia, and it was determined he had significant cardiac issues in his family history. Essentially all other tests were normal. The discontinuation of the intranasal use of timolol resolved any further episodes of lightheadedness and bradycardia. It was determined through genetic testing that he is an intermediate metaboliser of CYP2D6, the main enzyme contributing to the metabolism of timolol. This explains the development of the bradycardia after intranasal timolol use. The metabolising variants of CYP2D6 need to be considered when prescribing medications metabolised by this enzyme, so possible adverse effects can be avoided.
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Affiliation(s)
- Narendranath Epperla
- Department of Internal Medicine and Clinical Research, Marshfield Clinic, Marshfield, Wisconsin, USA
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