Pyogenic granuloma in a 5-month-old treated with topical timolol

Clinical Signs for Differential Diagnosis of Eyelid Tumours

This article aims to present the differential diagnostics of benign and malignant eyelid tumours. The most common malignant eyelid tumour is basal cell carcinoma, followed by squamous cell carcinoma. The common signs of malignity are loss of lashes, ulceration, and infiltration of the lesion. Often the clinical appearance is various and therefore only a histological analysis gives the proper diagnosis. For most tumours, surgical resection is the gold standard of therapy. The reconstruction of the defects should be performed by an experienced oculoplastic surgeon. In malignant tumours that require large safety margins, the defect can be easily very large, and the reconstruction must then be performed with advanced ophthalmic plastic reconstruction techniques.

Recurrent Cutaneous Pyogenic Granuloma of the Nose Following Rhinoplasty: A Case Report

Pyogenic granuloma (PG) is a vascular tumor originating from the skin and mucosal membranes. The most common sites include the oral and nasal cavities. It appears as a solitary erythematous lesion that bleeds easily. Various triggers were present in the literature such as pregnancy, drugs, and trauma. Trauma to the nose such as nose piercing was reported several times. However, there has been only one case study that has reported rhinoplasty as a potential trigger for the development of PG. Here, we report a case of recurrent PG following rhinoplasty in a 45-year old female.

Topical β-blockers for pyogenic granulomas: A promising option for younger patients

BACKGROUND

Topical β-blockers, propranolol, and timolol were used for pyogenic granuloma (PG) treatment; however, their efficacies and safety profiles were not compared.

AIMS

The aim was to evaluate the safety and efficacy of propranolol 1% and timolol 0.5% creams in the treatment of pyogenic granulomas.

PATIENTS

The study included 30 PG patients. They were divided into three groups (10 patients each). Group I patients received propranolol 1% cream. Group II patients used timolol 0.5% l cream. Group III patients used placebo cream. Creams were applied twice daily for 2 months. Patients were followed up for 3 months to detect any recurrence.

RESULTS

Complete resolution was reported in 6 patients of groups I and II, while none of the control patients reported complete resolution. Despite the absent change in lesions' size in 40% of β-blockers treated groups, they all reported decreased bleeding tendency. There was insignificant difference between the clinical responses between β-blockers groups. No recurrence was reported in any of the patients who achieved complete resolution after 3 months of follow-up. Younger patients respond better to β-blockers. Three patients were deteriorated on beta-blockers treatment.

CONCLUSION

β-blockers are a promising PG treatment option in cases where invasive modalities are not desirable especially in younger patients.

Topical 1% propranolol ointment with occlusion in treatment of pyogenic granulomas: An open-label study in 22 children

BACKGROUND

Pyogenic granuloma (PG) is a common, acquired, benign vascular neoplasm of the skin and mucous membranes. It occurs most often in children and adolescents. First-line treatment options for PG are based on destructive approaches. Pain, permanent scarring, and pigmentation are potential complications of these therapies.

METHODS

This single-arm, open-label, prospective study evaluated the efficacy of topical propranolol for treatment of PGs in children. All patients clinically diagnosed with cutaneous PG consecutively at the Dermatology Pediatric Outpatient Service of the University of Bologna from January 2010 to December 2010 received a compounded formulation of propranolol ointment 1%.

RESULTS

We found propranolol ointment to be effective in consecutive patients; 59.0% completely regressed in a mean of 66 days, 18.2% remained stable, and 22.7% did not respond. No side effects (eg, skin irritation, allergy, bleeding) were observed.

CONCLUSION

Topical propranolol ointment 1% with occlusion appears to be an effective treatment for PGs in children. Early treatment was associated with a more favorable outcome.

The role of β-blockers in dermatological treatment: a review

Many systemic medications have been used off-label in cutaneous diseases. Use of β-adrenergic-blocking agents has risen in popularity among dermatologists since the discovery of their efficacy in treating infantile haemangioma. There has also been an increase in the interest of the applications of β-blockers in other skin disorders. Overall, β-blockers are effective in treating diseases of vascular origin and promote wound healing. They are relatively safe and inexpensive medications that could be included in the armamentarium against skin diseases.

Inhibition of Angiofibromas in a Tuberous Sclerosis Patient Using Topical Timolol 0.5% Gel

Angiofibromas are the most recognized cutaneous manifestations of tuberous sclerosis complex. Angiofibromas can be associated with disfigurement, bleeding, pruritus, and erythema and may lead to significant psychosocial consequences for affected patients. Histopathologically, angiofibromas consist of a mixture of vascular and interstitial cells. Traditional treatment options include cryotherapy, electrocoagulation, radiofrequency ablation, dermabrasion, laser treatment, and topical agents such as podophyllotoxin. However, complications such as pain, postinflammatory hyperpigmentation, scarring, and the frequent recurrence rate reduce the utility of these treatment options. The introduction of topical rapamycin marked a turning point for treatment of facial angiofibromas; however, the lack of a standardized formulation, limited insurance coverage, and significant financial cost restrict universal access for patients and their caregivers. Both oral and topical β-blockers have proven extremely effective treatments for superficial vascular tumors such as hemangiomas and pyogenic granulomas. Topical β-blockers may potentially be useful for treatment of angiofibromas considering these lesions also contain a vascular component. Here we present an exploratory case report of a patient with tuberous sclerosis complex who had significant clinical improvement of her facial angiofibromas utilizing a "split-face" comparison protocol of topical timolol 0.5% gel after full-field treatment with ablative fractional laser resurfacing and pulsed-dye laser.