Lisa Weibel1,2, Marjam J Barysch2, Helene S Scheer1, Ingo Königs3, Kathrin Neuhaus4,5, Clemens Schiestl4,5, Katharina Rentsch6, Daniel M Müller7, Martin Theiler1,2. 1. Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland. 2. Department of Dermatology, University Hospital Zurich, Zurich, Switzerland. 3. Department of Pediatric Surgery, Pediatric Burn Unit and Plastic and Reconstructive Surgery in Children, Altonaer Kinderkrankenhaus & University Medical Center, Hamburg-Eppendorf, Germany. 4. Department of Plastic and Reconstructive Surgery, University Children's Hospital Zurich, Zurich, Switzerland. 5. Pediatric Burn Center, University Children's Hospital Zurich, Zurich, Switzerland. 6. Laboratory Medicine, University Hospital Basel, Basel, Switzerland. 7. Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.
Abstract
BACKGROUND: Topical use of timolol for infantile hemangiomas has recently emerged with promising results. It is unknown whether topical β-blockers act locally or if their effect is partly due to systemic absorption. This study investigates whether topically applied timolol is absorbed and reports on the efficacy of this treatment. METHODS: We treated 40 infants with small proliferating hemangiomas with topical timolol gel 0.5% twice daily and assessed urinary excretion and serum levels in a proportion of patients. Clinical response was evaluated on a visual analog scale of standardized photographs after 1, 2, 3, and 5 months. RESULTS: Forty infants with a median age of 18 weeks (range 2-35 wks) were included; 23 (58%) had superficial and 17 (42%) mixed-type hemangiomas. The median size was 3 cm(2) (range 0.1-15 cm(2) ) and nine hemangiomas were ulcerated. The hemangiomas improved significantly during treatment, with a median increase in visual analog scale of 7 points after 5 months (p < 0.001). Urinalysis for timolol was performed in 24 patients and was positive in 20 patients (83%). In three infants, serum levels of timolol were also measured and were all positive (median 0.16 ng/mL [range 0.1-0.18 ng/mL]). No significant side effects were recorded. CONCLUSION: Topical therapy with timolol is effective for infantile hemangiomas, but systemic absorption occurs. Serum levels in our patients were low, suggesting that using timolol for small hemangiomas is safe, but caution is advised when treating ulcerated or large hemangiomas, very young infants, or concomitantly using systemic propranolol.
BACKGROUND: Topical use of timolol for infantile hemangiomas has recently emerged with promising results. It is unknown whether topical β-blockers act locally or if their effect is partly due to systemic absorption. This study investigates whether topically applied timolol is absorbed and reports on the efficacy of this treatment. METHODS: We treated 40 infants with small proliferating hemangiomas with topical timolol gel 0.5% twice daily and assessed urinary excretion and serum levels in a proportion of patients. Clinical response was evaluated on a visual analog scale of standardized photographs after 1, 2, 3, and 5 months. RESULTS: Forty infants with a median age of 18 weeks (range 2-35 wks) were included; 23 (58%) had superficial and 17 (42%) mixed-type hemangiomas. The median size was 3 cm(2) (range 0.1-15 cm(2) ) and nine hemangiomas were ulcerated. The hemangiomas improved significantly during treatment, with a median increase in visual analog scale of 7 points after 5 months (p < 0.001). Urinalysis for timolol was performed in 24 patients and was positive in 20 patients (83%). In three infants, serum levels of timolol were also measured and were all positive (median 0.16 ng/mL [range 0.1-0.18 ng/mL]). No significant side effects were recorded. CONCLUSION: Topical therapy with timolol is effective for infantile hemangiomas, but systemic absorption occurs. Serum levels in our patients were low, suggesting that using timolol for small hemangiomas is safe, but caution is advised when treating ulcerated or large hemangiomas, very young infants, or concomitantly using systemic propranolol.
Authors: Da-Ae Yu; Se Hee Min; Jaeryong Song; Jong Seo Park; Hanjae Lee; Jungyoon Ohn; Kyu Han Kim Journal: Ann Dermatol Date: 2022-10 Impact factor: 0.722
Authors: Ilona J Frieden; Katherine B Püttgen; Beth A Drolet; Maria C Garzon; Sarah L Chamlin; Elena Pope; Anthony J Mancini; Christine T Lauren; Erin F Mathes; Dawn H Siegel; Deepti Gupta; Anita N Haggstrom; Megha M Tollefson; Eulalia Baselga; Kimberly D Morel; Sonal D Shah; Kristen E Holland; Denise M Adams; Kimberly A Horii; Brandon D Newell; Julie Powell; Catherine C McCuaig; Amy J Nopper; Denise W Metry; Sheilagh Maguiness Journal: Pediatr Dermatol Date: 2020-05-16 Impact factor: 1.997