Weibel Lisa, Barysch Marjam J, Scheer Helene S, Königs Ingo, Neuhaus Kathrin, Schiestl Clemens, Rentsch Katharina, Müller Daniel M, Theiler Martin
Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.
Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
Pediatr Dermatol. 2016 Mar-Apr;33(2):184-90. doi: 10.1111/pde.12767. Epub 2016 Feb 3.
Topical use of timolol for infantile hemangiomas has recently emerged with promising results. It is unknown whether topical β-blockers act locally or if their effect is partly due to systemic absorption. This study investigates whether topically applied timolol is absorbed and reports on the efficacy of this treatment.
We treated 40 infants with small proliferating hemangiomas with topical timolol gel 0.5% twice daily and assessed urinary excretion and serum levels in a proportion of patients. Clinical response was evaluated on a visual analog scale of standardized photographs after 1, 2, 3, and 5 months.
Forty infants with a median age of 18 weeks (range 2-35 wks) were included; 23 (58%) had superficial and 17 (42%) mixed-type hemangiomas. The median size was 3 cm(2) (range 0.1-15 cm(2) ) and nine hemangiomas were ulcerated. The hemangiomas improved significantly during treatment, with a median increase in visual analog scale of 7 points after 5 months (p < 0.001). Urinalysis for timolol was performed in 24 patients and was positive in 20 patients (83%). In three infants, serum levels of timolol were also measured and were all positive (median 0.16 ng/mL [range 0.1-0.18 ng/mL]). No significant side effects were recorded.
Topical therapy with timolol is effective for infantile hemangiomas, but systemic absorption occurs. Serum levels in our patients were low, suggesting that using timolol for small hemangiomas is safe, but caution is advised when treating ulcerated or large hemangiomas, very young infants, or concomitantly using systemic propranolol.
噻吗洛尔局部用于婴儿血管瘤最近已出现且效果良好。尚不清楚局部应用β受体阻滞剂是局部起作用还是其效果部分归因于全身吸收。本研究调查局部应用的噻吗洛尔是否被吸收，并报告该治疗方法的疗效。
我们对40例患有小的增殖期血管瘤的婴儿，每日两次局部应用0.5%噻吗洛尔凝胶进行治疗，并对部分患者评估尿排泄及血清水平。在1、2、3和5个月后，根据标准化照片的视觉模拟量表评估临床反应。
纳入了40例中位年龄为18周（范围2 - 35周）的婴儿；23例（58%）为浅表型血管瘤，17例（42%）为混合型血管瘤。中位大小为3 cm²（范围0.1 - 15 cm²），9个血管瘤发生溃疡。治疗期间血管瘤明显改善，5个月后视觉模拟量表评分中位数增加7分（p < 0.001）。对24例患者进行了噻吗洛尔的尿液分析，20例患者（83%）结果为阳性。对3例婴儿也检测了血清噻吗洛尔水平，均为阳性（中位数0.16 ng/mL [范围0.1 - 0.18 ng/mL]）。未记录到明显副作用。
噻吗洛尔局部治疗婴儿血管瘤有效，但会发生全身吸收。我们患者的血清水平较低，提示对于小的血管瘤使用噻吗洛尔是安全的，但在治疗溃疡型或大型血管瘤、非常小的婴儿或同时使用全身性普萘洛尔时建议谨慎。
