Oral propranolol with topical timolol effectively treats infantile hemangiomas

Baltimore, Maryland: Oral propranolol, a systemic beta-blocker with the risk of rare but serious adverse effects, is the first-line therapy for infantile hemangiomas (IH). A recent study published has shown the effectiveness of sequential therapy with oral propranolol followed by topical timolol for IH compared to treatment with oral propranolol alone.

The study, published in the journal Pediatric Dermatology, has found that the sequential therapy with oral propranolol followed by topical timolol minimized potential adverse effects of systemic beta‐blockers. The treatment reduced the duration of propranolol therapy and facilitated successful taper at a younger age without an increase in treatment failures.

Infantile hemangiomas are common vascular tumors which typically double in size by 2 months of age, reach 80% of their maximum size by age 3- 5 months, and continue to proliferate at a slower rate until age 6- 12 months. Most IH then develops the signs of involution such as graying of the surface or flattening of the deeper component as vascular tissue is replaced by fibrosis and fat.

Topical timolol presents an attractive off-label alternative to oral propranolol with good tolerability, but sequential therapy with propranolol followed by timolol is not well studied. Katherine Puttgen, Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues report effects of topical timolol preceding or following oral propranolol as an adjunct therapy for IH.

The researchers conducted a retrospective chart review of 559 patients with IH between December 2008 and January 2018. Children were divided on the basis of the treatment received: propranolol only, timolol only, propranolol to timolol, timolol to propranolol to timolol, and timolol to propranolol. Patient demographics, clinical/treatment characteristics, and pairwise differences were explored between groups.

They found that:

• Among all patients treated with propranolol, those who received propranolol followed by timolol received the shortest duration of oral propranolol and were the youngest at the time of propranolol completion.


• These patients received propranolol for a median of 2.2 months duration and were a median of 1.7 months younger compared with patients who received oral propranolol only.


• None had treatment failure defined as requiring propranolol reinitiation, compared with 13% of patients in the propranolol only group.

"These results suggest that sequential oral to topical beta-blocker therapy can be an effective treatment strategy for IH and offers a method to minimize the potential adverse effects of systemic beta-blockers by shortening exposure to oral propranolol," concluded the authors.

For detailed study follow the link: https://doi.org/10.1111/pde.13816