topical timolol solution in hemangioma in thailand

7/31/2019 Topical Timolol Solution in Hemangioma in Thailand

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Response of InfantileResponse of Infantile HemangiomaHemangiomato Topicalto Topical TimololTimolol

ChestsadaChestsada TonusinTonusin


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Background & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & Rationale

Hemangioma (IH) is the most common

vascular tumors in children

Occur on any parts of

body, but most common onhead & neck

Fuchsmann et al. Arch Otolaryngol Head Neck Surg 2011;137(5):471-8


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Background & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & Rationale

More than 90% of IH has spontaneousinvolution by 9 yrs

Haggstrom et al. Pediatrics 2006;118(3):882-7.


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Background & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & RationaleBackground & Rationale Corticosteroids is the main drug for

treatment of IH with potential for manyside effects.

2008 oral propanolol was reported

effectively for treatment of IH, but withcaution of its side effects.

2010 first successful case

report of topical propanololin treatment of superficial

periorbital IHFuchsmann et al

.

Arch Otolaryngol Head Neck Surg 2011;137(5):471-8


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ObjectivesObjectivesObjectivesObjectivesObjectivesObjectivesObjectivesObjectives

To study the effectiveness and sideTo study the effectiveness and sideeffects of topicaleffects of topical timololtimololmaleate,0.5%,solution for IHmaleate,0.5%,solution for IH


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MethodologyMethodology Retrospective descriptive studyRetrospective descriptive study

JuneJune December 2011December 2011

Apply 2 drops of 0.5% topicalApply 2 drops of 0.5% topical timololtimolol

solution BID for 4 monthssolution BID for 4 months

Evaluate every month for 4 monthsEvaluate every month for 4 months


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MethodologyMethodology

Inclusion criteriaInclusion criteria

Size < 5 cm. without complicationSize < 5 cm. without complication

Exclusion criteriaExclusion criteria

Underlying heart diseaseUnderlying heart disease

AsthmaAsthma

Use other drugsUse other drugs


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MethodologyMethodology

RResponse determined by reduction of sizeesponse determined by reduction of size

and/or color of IHand/or color of IH

ClinicalClinical

Comparison of photograph every visitComparison of photograph every visit

Results reported in mean & percentResults reported in mean & percent


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Operation DefinitionOperation DefinitionOperation DefinitionOperation DefinitionOperation DefinitionOperation DefinitionOperation DefinitionOperation Definition

Complete resolution

Complete clear both color & size

Partial resolution

Partial clear of color OR size

Treatment failure

No response OR progression


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ResultsResults


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ResultsResults

25 patients with 28 IH lesions25 patients with 28 IH lesions

Male : Female ratio = 1 : 2.1Male : Female ratio = 1 : 2.1

Mean age = 10 mo. (range 2-29 mo)

Site of IHs: Face 19 lesions (Periorbital 10, cheeks 4,

nose 1, ear 1 & neck 3)

Trunk & arm 9 lesions (trunk 6, arm 3)


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ResultsResults

Type : Superficial 22 cases (78%)

Mix 6 cases (22%) Preterm 5 cases(20%)

2 cases has family history of IH (20%)


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Response of size to treatmentResponse of size to treatment


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Response of color to treatmentResponse of color to treatment


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Response to treatmentResponse to treatment


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Before After 4 months


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Before

After 4 months


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Side EffectsSide Effects

There were no side effects.There were no side effects.


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DiscussionDiscussion


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DiscussionDiscussion Mechanism of action of propanolol

1. Local vasoconstriction2. Down regulation of RAF/mitogen

activated protein kinase pathway

3. Decreased expression VEGF & bFGFgenes

4. Apoptosis of capillary endothelial cells


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Literature reviewLiterature reviewLiterature reviewLiterature reviewLiterature reviewLiterature reviewLiterature reviewLiterature review

Study/YrStudy/Yr DesignDesign MethodMethod OutcomesOutcomes

KunziKunzi--

Rapp KRapp K20122012

Case seriesCase series

gr1 age< 6gr1 age< 6mo;45pt. ,67mo;45pt. ,67superficial IHsuperficial IH

1%1% propanololpropanolol

ointment bid,ointment bid, useusephotograph &photograph &

u/su/s to measuresto measuresthicknessthickness

reduced in size,reduced in size,

thickness, colorthickness, color59%, stop growth59%, stop growth26%, no response26%, no response

15%15% in gr1,in gr1,

improve in gr2improve in gr2No ADRNo ADR

gr2 age 7gr2 age 7--3333

mo, 6 pt, 10mo, 6 pt, 10mixed IHmixed IH

ChakkittaChakkitta

kandiyilkandiyilet alet al

20122012

RetrospectRetrospect

multicentermulticenter,,cohort studycohort study6pt, head&6pt, head&neck IHneck IH

0.1/0.5%0.1/0.5% timololtimolol

gel bid usegel bid usephotograph &photograph & VASVAS

all but 1 improved;all but 1 improved;

better response in:better response in:superficial type, usesuperficial type, use

0.5%0.5% timololtimolol, use >, use >

3 mo;3 mo;

ADR: disturb sleepADR: disturb sleep11 casecase


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DiscussionDiscussion PeriorbitalPeriorbital IHIH responsedresponsed best tobest to

treatment.treatment. Different results arised from:

No standard protocol available

Vehicle of drug

Amount of drug

Duration of treatment

Different measuring methods

Patients compliance


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DiscussionDiscussion

Limitation in this study is lack of

standardized measurement tools


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ConclusionConclusion

TopicalTopical timololtimolol maleatemaleate, 0.5%, solution, 0.5%, solution

provided a safe and effectiveprovided a safe and effectivealternative treatment for superficialalternative treatment for superficial

hemangiomahemangioma especiallyespecially periorbitalperiorbital area.area.


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topical timolol solution in hemangioma in thailand

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