Topical treatment for infantile hemangiomas warrants further studies

Key takeaways:

• Of 145 infants with infantile hemangiomas treated with topical 0.5% timolol maleate hydrogel, 89 showed an excellent response and 44 showed a good response.
• 12 patients did not respond to treatment.

Topical 0.5% timolol maleate hydrogel may be a better alternative to oral propranolol in the treatment of infantile hemangiomas, according to a study.

A common tumor in childhood, infantile hemangiomas (IHs) are self-limiting vascular endothelial tumors often found on the head and neck. The tumors have an overall incidence of 22% to 30% among preterm infants.

“Without intervention, complete resolution occurs in about 49% of patients by age 5 and 72% of patients by age 7,” Fariha Anwar, MS, of the Rawalpindi Medical University in Pakistan, and colleagues wrote. “Although typically benign, IH lesions may lead to functional impairment and cosmetic disfigurement such as complicated ulcerations, bleeding or infections.”

Medical intervention is required in about 10% to 20% of IH cases, and if certain serious cases are left untreated, they could lead to high-output cardiac failure, impingement on vital structures or brain invasion, according to the study.

Oral propranolol is the current first-line treatment for IH, the researchers wrote, but can cause serious side effects due to its ability to penetrate the brain blood barrier.

Anwar and colleagues conducted a quasi-experiment to evaluate the efficacy of 0.5% timolol maleate hydrogel, a nonselective beta blocker that may be an alternative treatment option for IH.

Conducted from October 2020 to April 2021, the study included 145 infants (mean age, 6.1 months; 70.3% boys) aged 1 to 12 months with superficial IH. The gel was applied to the IH three times daily while researchers tracked the progress of recovery through photos and measurements taken every month for 6 months.

Results showed that 89 patients showed an excellent response and 44 patients showed a good response, whereas there was no response in 12 patients. There were no significant differences in response rate between the group aged 1 to 6 months and the group aged 7 to 12 months.

Based on these results, the authors believe that 0.5% timolol maleate hydrogel is worth investigating further in trials that have a placebo group and can collect safety data.

“The lower rate of systemic side effects as compared to oral beta blockers may make topicals a more desirable option,” the authors concluded.