Department of Dermatology, University of California Davis School of Medicine, Institute for Regenerative Cures, 2921 Stockton Blvd, Ste 1630, Sacramento, CA, 95817, USA.
Dermatology Service, VA Northern California Health Care System, Mather, CA, USA.
Am J Clin Dermatol. 2021 Jan;22(1):89-99. doi: 10.1007/s40257-020-00567-3. Epub 2020 Nov 25.
Ophthalmic timolol solution is increasingly being repurposed as a topical therapeutic for a variety of dermatologic diseases, including pyogenic granulomas, infantile hemangiomas, and chronic wounds. There are no published guidelines or protocols for use in these indications in adults, and the dermatologic community may not be familiar with adverse events that have been extensively documented relating to its ophthalmic use. We review the evidence available relating to adverse events to topical timolol use to evaluate its safety in dermatologic applications and to alert clinicians to screening and monitoring that is needed when repurposing this drug for dermatologic use. The majority of serious adverse events associated with ophthalmic timolol were reported in the first 7 years of use, between 1978 and 1985, of which most common were cardiovascular and respiratory events, but also included 32 deaths. The available evidence suggests that ophthalmic timolol safety profiling may have been incomplete prior to widespread use. Recent clinical trials for dermatologic indications have focused on documenting efficacy and have not had rigorous monitoring for potential adverse events. Topical timolol may be safe and effective for the treatment of various dermatologic conditions in patients whose medical histories have been carefully reviewed for evidence of pre-existing cardiac or pulmonary disease and are monitored for potential adverse events. Despite the wide use of timolol in ophthalmologic practice, safe dermatologic repurposing requires recognition of the potential for facilitated systemic absorption though the skin and appreciation of its history of adverse events.
眼科用噻吗洛尔溶液越来越多地被重新用作治疗各种皮肤科疾病的局部治疗药物，包括化脓性肉芽肿、婴儿血管瘤和慢性创面。目前，尚无关于成人在这些适应证中使用的指南或方案，皮肤科医生可能不熟悉已广泛记录的与眼科用途相关的不良事件。我们回顾了与局部使用噻吗洛尔相关的不良事件的现有证据，以评估其在皮肤科应用中的安全性，并提醒临床医生在将这种药物重新用于皮肤科用途时需要进行筛查和监测。与眼科用噻吗洛尔相关的大多数严重不良事件是在 1978 年至 1985 年使用后的头 7 年报告的，其中最常见的是心血管和呼吸系统事件，但也包括 32 例死亡。现有证据表明，在广泛使用之前，眼科用噻吗洛尔的安全性评估可能并不完整。最近针对皮肤科适应证的临床试验主要集中在记录疗效上，而对潜在不良事件的监测并不严格。对于病史经过仔细审查以排除存在潜在心脏或肺部疾病并监测潜在不良事件的患者，局部使用噻吗洛尔可能安全有效，可用于治疗各种皮肤科疾病。尽管噻吗洛尔在眼科实践中广泛使用，但安全的皮肤科再利用需要认识到通过皮肤促进全身吸收的可能性，并了解其不良事件的历史。
