Abstract
Objective: Infantile hemangiomas (IHs) are the most common vascular tumors of infancy. Oral propranolol has achieved great success in treating IHs since 2008. To minimize the systemic side events caused by oral administration of propranolol, topical timolol started to be applied in the treatment of IHs, especially for superficial lesions.Methods: We treated 724 children with superficial IHs using oral propranolol or topical timolol, and investigated the efficacy and safety of the two treatment patterns.Results: Both oral propranolol and topical timolol achieved a satisfactory therapeutic outcome, with an effective response rate of 97 and 96.4%, respectively. No significant differences in visual analog scale (VAS) improvement between the two groups were observed. Occurrence rate of systemic adverse events for patients treated with oral propranolol (3.9%) was significantly higher than that for patients treated with topical timolol (0%). Clinical response was not associated with gender, duration of treatment, lesion location, lesion size, gestational age, and progesterone use during pregnancy, but closely associated with age at treatment initiation, which indicated that younger age at treatment initiation predicted for a better regression rate.Conclusions: We recommend that topical timolol instead of oral propranolol could be the first-line therapy for superficial IHs because of its good efficacy and improved safety.
Highlights
Infantile hemangiomas (IHs) are the most common vascular tumors of infancy [1]
We conducted a comparative cohort study to evaluate the outcomes of superficial IHs treated with either topical timolol or oral propranolol, and possible adverse events (AEs)
Our results based on large samples demonstrated that both oral propranolol and topical timolol are effective for treating superficial IHs, and there were no significant differences in efficacy between the two treatment modalities
Summary
Infantile hemangiomas (IHs) are the most common vascular tumors of infancy [1]. Owing to the characteristic growth pattern of IHs with rapid proliferation and followed involution, conservative therapy strategies based on observation without early interference were prevalent over several decades [3]. Observational treatment failed to achieve satisfactory therapeutic effects because of the slow rate of tumor regression and permanent residuals leading to cosmetic problems [4]. Early and active intervention has become the first choice for proliferating IHs. In 2008, Léauté-Labrèze et al [5] reported their results of successfully treating IHs with oral propranolol. Propranolol has become the first-line drug for IHs, but its molecular mechanisms are not well-elucidated [6].
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