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Comparison of the Efficacy of Combined Silver Nitrate Coagulation and Shave Excision With Surgical Excision and Linear Closure in the Treatment of Pyogenic Granuloma. Dermatol Surg 2023; 49:473-478. [PMID: 36892556 DOI: 10.1097/dss.0000000000003748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
BACKGROUND Pyogenic granuloma (PG) is a common benign vascular neoplasia. Optimal treatment should have an aesthetically pleasant scar and a low recurrence rate. No treatment method that is fully effective in solving these has been demonstrated. Silver nitrate cauterization is another method for the management of PG lesions. OBJECTIVE The effects of silver nitrate on the treatment of PG have not been sufficiently investigated and should be investigated with objective data and a controlled study. METHODS The prospective clinical trial was designed to compare silver nitrate cauterization with surgical excision treatment. Procedure times and procedure costs, comfort and satisfaction scales, recurrences, the Patient and Observer Scar Assessment Score, and the Vancouver Scar Scale were compared to evaluate treatments. RESULTS Silver nitrate treatment had lower procedure times, costs, and better satisfaction and comfort scale scores. The scar assessment scores were better for the silver nitrate treatment. The patients in both groups were successfully treated and no recurrence was seen. CONCLUSION Silver nitrate cauterization is low-cost, fast, safe, reliable, and effective with good aesthetic results for the treatment of PG lesions. This study shows that silver nitrate cauterization is a good alternative to surgical excision in the management of PG.
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Alhazmi AM, Basendwh MA, Aman AA, Dajam M, Aljuhani TS. The Role of Systemic and Topical Beta-Blockers in Dermatology: A Systematic Review. Dermatol Ther (Heidelb) 2022; 13:29-49. [PMID: 36414845 PMCID: PMC9823192 DOI: 10.1007/s13555-022-00848-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Beta-blockers are proven to be safe and cost-effective agents in treating multiple dermatological conditions, which is why they are considered as an interesting and good alternative therapeutic agent by dermatologists. To our knowledge, there has been no comprehensive systematic review to date summarizing the role of both systemic and topical beta-blockers in dermatology. METHODS In this systematic review, we aim to review recent and relevant published literature in order to provide a comprehensive evidence-based summary to inform dermatologists. RESULTS An electronic-based literature search was carried out during October-December 2021 in the databases PubMed (MEDLINE), SCOPUS (EMBASE), and Cochrane Library. Furthermore, bibliographic sources were also reviewed for the selected articles. We followed The Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA) guidelines. We reviewed published literature about the role of beta-blockers in dermatology for the time period (January 2016 to December 2021). CONCLUSIONS A total of 126 publications were retrieved from different databases, of which 59 studies were finally included in our review after excluding non-eligible literature in accordance with our inclusion and exclusion criteria. The included articles consisted of meta-analyses, systematic reviews, clinical trials, retrospective and prospective cohort studies, case-control studies, case series, and case reports. In general, data in reviewed literature showed that both systemic and topical beta-blockers were reliable and safe therapeutic options in treating different dermatoses. Their effect has been studied as a mono-therapy, also as an adjuvant therapy combined with other current disease-specific therapeutic modalities such as lasers, radiation, chemotherapy, corticosteroids, or other beta-blockers options. Local and systemic adverse effects were mainly minor and non-significant.
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Affiliation(s)
- Alya M Alhazmi
- King Fahd Armed Forces Hospital, Saudi Arabian Ministry of Defence and Aviation, Al Kurnaysh Rd, Al Andalus, PO Box 23311, Jeddah, Saudi Arabia.
| | - Mohammad A Basendwh
- King Fahd Armed Forces Hospital, Saudi Arabian Ministry of Defence and Aviation, Al Kurnaysh Rd, Al Andalus, PO Box 23311, Jeddah, Saudi Arabia
| | | | - Mazen Dajam
- King Fahd Armed Forces Hospital, Saudi Arabian Ministry of Defence and Aviation, Al Kurnaysh Rd, Al Andalus, PO Box 23311, Jeddah, Saudi Arabia
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Gaw CE, Treat JR, Friedlaender EY, Del Pizzo J. Management of Bleeding Pyogenic Granulomas in Acute Care Settings. J Emerg Med 2022; 63:339-347. [DOI: 10.1016/j.jemermed.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/29/2022] [Accepted: 04/23/2022] [Indexed: 11/07/2022]
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Filoni A, Ambrogio F, De Marco A, Pacifico A, Bonamonte D. Topical beta-blockers in dermatologic therapy. Dermatol Ther 2021; 34:e15016. [PMID: 34075667 PMCID: PMC8459235 DOI: 10.1111/dth.15016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/24/2021] [Indexed: 12/25/2022]
Abstract
An increasing use of beta-blockers in dermatology has been described over the last 10 years, despite the fact that their use in diseases other than infantile hemangiomas is off-label. This review discusses the emerging role of topical beta-blockers in the treatment of infantile hemangioma, but also pyogenic granuloma, Kaposi sarcoma, wounds and nail paronychia. Data in literature demonstrate that topical beta-blockers are a safe and valid therapeutic option in numerous cutaneous diseases. Side effects are mainly restricted to the application site. Further studies and randomized trials may contribute to reinforce the role of topical beta-blockers in the dermatological armamentarium.
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Affiliation(s)
- Angela Filoni
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy.,Section of Dermatology, Perrino Hospital, Brindisi, Italy
| | - Francesca Ambrogio
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Aurora De Marco
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Alessia Pacifico
- Phototherapy Unit, San Gallicano Dermatological Institute, Rome, Italy
| | - Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
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Jaiswal H, Patidar N, Shah C, Singh R, Jain E, Piyush P. Topical timolol 0.5% as the primary treatment of ophthalmic pyogenic granuloma: A prospective, single-arm study. Indian J Ophthalmol 2021; 69:1155-1160. [PMID: 33913850 PMCID: PMC8186631 DOI: 10.4103/ijo.ijo_2404_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: To study topical timolol (0.5%) as a first-line treatment in ophthalmic pyogenic granuloma (PG) in terms of safety and efficacy. Methods: This was a prospective, interventional, single-arm study conducted at a tertiary eye care hospital in central India. Only new cases of PG were counseled to get enrolled in the study. A total of 40 patients were analyzed in the study. Topical timolol eye drop (0.5%) was started in each patient twice daily for 4–6 weeks duration. The patients were divided into five categories according to the percentage reduction in the size of PG as follows: i) 80–100% reduction - excellent responders, ii) 60–80% – good, iii) 40–60% – satisfactory, iv) 20–40% – poor, and v) <20% – very poor/nonresponder. After 6 months of starting treatment final evaluation was done. Results: The mean age of the patients was 23.5 ± 13.3 years. Etiology of the disease included chalazion (n = 11, 27.5%), trauma (n = 2, 5%), surgery (n = 7, 17.5%), foreign body (n = 2, 5%), and idiopathic (n = 18, 45%). An excellent response was achieved in 31 (77.5%) patients. Twenty-seven (67.5%) patients had complete resolution of lesions within 6 weeks. Recurrence of the lesion was not noticed in any patients. Conclusion: Timolol 0.5% in topical form is a good treatment option for ophthalmic PG in all age groups. The treatment has no adverse effects when given to suitable individuals for a limited period.
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Affiliation(s)
- Hrishabh Jaiswal
- Department of Orbit and Oculoplasty, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Narendra Patidar
- Department of Orbit and Oculoplasty, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Chintan Shah
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Rukmendra Singh
- Department of Orbit and Oculoplasty, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Elesh Jain
- Consultant and Administrator, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Parimal Piyush
- Department of Orbit and Oculoplasty, Sadguru Netra Chikitsalya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
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El-Taweel AEAI, Al-Refaie AAASA, Salem KHA, Salem RM. Topical β-blockers for pyogenic granulomas: A promising option for younger patients. J Cosmet Dermatol 2020; 20:1801-1806. [PMID: 33128492 DOI: 10.1111/jocd.13800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 01/25/2023]
Abstract
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.
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Abstract
Vascular tumors are a rare subset of vascular anomalies. These are classified based on their malignant potential or local destruction potential. Classification has been historically difficult and treatment recommendations are based on case series. The purpose of this chapter is to review the presentation, pathologic and imaging characteristics. Treatment recommendations are summarized based on the current literature. Congenital and infantile hemangiomas are covered separately in a separate chapter in this issue.
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Affiliation(s)
- Sara A Mansfield
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Regan F Williams
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ionela Iacobas
- Cancer and Hematology Center, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, United States.
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Stüssel P, Schulze Dieckhoff K, Künzel S, Hartmann V, Gupta Y, Kaiser G, Veldkamp W, Vidarsson G, Visser R, Ghorbanalipoor S, Matsumoto K, Krause M, Petersen F, Kalies K, Ludwig RJ, Bieber K. Propranolol Is an Effective Topical and Systemic Treatment Option for Experimental Epidermolysis Bullosa Acquisita. J Invest Dermatol 2020; 140:2408-2420. [PMID: 32450072 DOI: 10.1016/j.jid.2020.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/30/2020] [Accepted: 04/12/2020] [Indexed: 12/14/2022]
Abstract
Propranolol is an ADRB2 blocker that regulates heart muscle contractions, smooth muscle relaxation, and glycogenolysis. In addition, an increasing number of applications in dermatology have been described, most prominently, the use as a first-line treatment for infantile hemangiomas. We here show that propranolol enhances IL-8-induced neutrophil chemotaxis and reduces the release of ROS after immune complex stimulation. To obtain further molecular insights into the modulatory effects of propranolol in activated neutrophils, we performed RNA sequencing of immune complex-stimulated neutrophils in the absence and presence of the drug. We identified the transcriptomic signature of propranolol and demonstrated an ADR2-independent immunomodulatory effect. To determine if the anti-inflammatory transcriptomic signature of propranolol also translates into clinical effects, we next evaluated the impact of propranolol in a prototypical neutrophil-dependent skin disease, specifically, antibody transfer-induced epidermolysis bullosa acquisita in mice. To validate the identified propranolol gene signature obtained in human neutrophils, we analyzed a selection of genes by RT-PCR in mouse epidermolysis bullosa acquisita skin and confirmed TNF, among others, to be differentially regulated by propranolol treatment. Our data clearly indicate that, based on its molecular impact on immune complex-activated neutrophils, propranolol is a potential treatment option for neutrophil-mediated inflammatory skin diseases.
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Affiliation(s)
- Pia Stüssel
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | | | - Sven Künzel
- Max-Planck Institute for Evolutionary Biology, Plön, Germany
| | - Veronika Hartmann
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Yask Gupta
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Georg Kaiser
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | | | - Gestur Vidarsson
- Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Remco Visser
- Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
| | | | - Kazuko Matsumoto
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Malin Krause
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Frank Petersen
- Priority Area Asthma and Allergy, Members of the German Center for Lung Research, Research Center Borstel, Borstel, Germany
| | | | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany.
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Sibaud V, Casassa E, D'Andrea M. Are topical beta-blockers really effective "in real life" for targeted therapy-induced paronychia. Support Care Cancer 2019; 27:2341-2343. [PMID: 30847700 DOI: 10.1007/s00520-019-04690-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/05/2019] [Indexed: 12/30/2022]
Abstract
Paronychia and periungual pyogenic granuloma represent one of the most common and bothersome dermatologic toxicities observed with ErbB inhibitors. There is no standardized treatment, and management remains challenging. Moreover, conservative management with noninvasive treatment should be promoted for fragile patients in a metastatic setting. Over the last few years, the efficacy of topical blocking agents has been considered for managing cutaneous or mucosal pyogenic granulomas. Very recently, the use of topical propranolol or of timolol has been reported in several patients undergoing treatment with EGFR inhibitors and developing pyogenic granulomas of the nail. We performed a retrospective single-center review of patients with targeted therapy-related paronychia/periungual pyogenic granulomas who had been treated with topical timolol, either alone or in combination with other topical treatments. Nearly two thirds of patients showed at least a partial response after 1 month of therapy, and the use of a topical beta-blocker in our population was associated with a favorable safety profile. Finally, topical timolol may represent a promising treatment option for the management of cancer patients suffering from painful periungual lesions. Comparative clinical trials, however, are still needed.
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Affiliation(s)
- Vincent Sibaud
- Oncodermatology, Institut Claudius REGAUD and Institut Universitaire du Cancer Toulouse Oncopole, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France.
| | - Eline Casassa
- Oncodermatology, Institut Claudius REGAUD and Institut Universitaire du Cancer Toulouse Oncopole, 1 avenue Irène Joliot-Curie, 31059, Toulouse Cedex 9, France
| | - Mirella D'Andrea
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples "Federico II", Naples, Italy
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Padula C, Nicoli S, Pescina S, Santi P. Thin polymeric films for the topical delivery of propranolol. Colloids Surf B Biointerfaces 2019; 174:582-586. [DOI: 10.1016/j.colsurfb.2018.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 12/16/2022]
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Mashiah J, Hadj-Rabia S, Slodownik D, Harel A, Sprecher E, Kutz A. Effectiveness of topical propranolol 4% gel in the treatment of pyogenic granuloma in children. J Dermatol 2018; 46:245-248. [DOI: 10.1111/1346-8138.14740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/13/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Jacob Mashiah
- Pediatric Dermatology Unit; Dana Children's Hospital; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Department of Dermatology; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Smail Hadj-Rabia
- Department of Dermatology; Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC); Hôpital Universitaire Necker-Enfants Malades, AP-HP; Paris France
- Institut Imagine; INSERM U1163; Paris France
- Université Paris Descartes-Sorbonne Paris Cité; Paris France
| | - Dan Slodownik
- Department of Dermatology; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Avikam Harel
- Pediatric Dermatology Unit; Dana Children's Hospital; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Eli Sprecher
- Pediatric Dermatology Unit; Dana Children's Hospital; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Department of Dermatology; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ana Kutz
- Pediatric Dermatology Unit; Dana Children's Hospital; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
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Plachouri K, Georgiou S. Therapeutic approaches to pyogenic granuloma: an updated review. Int J Dermatol 2018; 58:642-648. [DOI: 10.1111/ijd.14268] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/06/2018] [Accepted: 09/21/2018] [Indexed: 12/11/2022]
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