- This study investigated the effects of topical timolol administered either prior to or following oral propranolol for infantile hemangiomas (IH). Compared with patients treated with propranolol only, those who were subsequently treated with timolol had a shorter length of propranolol treatment (median, 2.2 months; P=.006) and were younger at the time of treatment completion (median, 1.7 months younger; P=.007). No patient in the sequential therapy group experienced treatment failure compared with 13% patients in the propranolol-only group (P = .036).
- These data suggest that oral propranolol followed by a topical beta blocker for IH may allow faster and more successful tapering of propranolol, leading to reduction in the potential associated adverse events as well as a decreased risk of treatment failure.
– InYoung Kim, MD, PhD
Abstract
BACKGROUND/OBJECTIVES
First-line therapy for infantile hemangiomas (IH) is oral propranolol, a systemic beta-blocker with the risk of rare but serious adverse effects. Topical timolol presents an attractive off-label alternative with good tolerability, but sequential therapy with propranolol followed by timolol is not well studied. Here, we report effects of topical timolol preceding or following oral propranolol as adjunct therapy for IH.
METHODS
A retrospective chart review of 559 patients with IH seen at the pediatric dermatology clinic of a tertiary care center between December 2008 and January 2018. Children were grouped by 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.
RESULTS
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 (P = 0.006) and were a median of 1.7 months younger (P = 0.007) 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 (P = 0.036).
CONCLUSIONS
Sequential therapy with oral propranolol followed by topical timolol for IH may help minimize potential adverse effects of systemic beta-blockers by reducing the duration of propranolol therapy and facilitating successful taper at a younger age without an increase in treatment failures.
Pediatric Dermatology
Topical Timolol as Adjunct Therapy to Shorten Oral Propranolol Therapy for Infantile Hemangiomas
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