DOI: http://dx.doi.org/10.18203/2349-2902.isj20211288

Comparative study in treatment of haemangioma with oral propranolol and combination effect of oral propranolol and topical timolol solution

Ashok Laddha, Brijesh Kumar Lahoti, Pavankumar More, Shashi Shankar Sharma, Pooja Tiwari, Harshita Kakoriya, Shashank Singh Baghel, Ram Mohan Shukla

Abstract


Background: Haemangioma of infancy usually regresses on its own but recently there has been trend of use of beta blockers like propranolol. Here we assess the improvement in efficacy of combination of propranolol with timolol in decreasing lesion size and colour change. And assess whether the combination decreases the duration of the treatment.

Methods: Total of 40 patients were included in our study with surface haemangioma under 12 years. Divided in to two groups of 20 each oral propranolol and timolol and propranolol only, treated for 6 months and were assessed by monthly measurements of lesion dimensions using measuring tape, USG and colour changes noted by clinical photographs on monthly basis. VAS scale was used to grade the improvements. Comparisons were made between the groups with statistical analysis.

Results: VAS grade comparisons were insignificant p>0.05. Mean treatment duration was 4.65±2.601 months for Propranolol with timolol group and 5.50±3.171 months for propranolol only group. Statistically significant outcomes between 2 groups were noted in the depth category and total volume reduction of the lesion with p=0.019 and 0.033 respectively, in the subset of 0-12 months only with p=0.038.

Conclusions: Clinically there is Volumetric reduction in terms depth reduction and a decrease in duration of treatment. Propranolol 2-3 mg/kg and Timolol solution of 0.5% applied thrice over the lesion was well tolerated without any serious adverse events. The combination therapy fails to demonstrate a statistically approvable shorter period of treatment as well as better efficacy when compared to oral propranolol alone.


Keywords


Propranolol, Timolol, Haemangioma, Combined therapy, Efficacy

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References


Finn MC, Glowacki J, Mulliken JB. Congenital vascular lesions: clinical application of a new classification. J Pediatr Surg. 1983;18(6):894-900.

Luu M, Frieden IJ. Haemangioma: clinical course, complications and management. Br J Dermatol. 2013;169(1):20-30.

Margileth AM, Museles M. Cutaneous hemangiomas in children. Diagnosis and conservative management. JAMA. 1965;194(5):523-6.

Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358(24):2649-51.

Nguyen HP, Pickrell BB, Wright TS. Beta-blockers as therapy for infantile hemangiomas. Seminar’s plastic surg. 2014;28(2):87-90.

Gunturi N, Ramgopal S, Balagopal S, Scott JX. Propranolol therapy for infantile hemangioma. Indian Pediatr. 2013;50(3):307-13.

Li X, Yang K, Li H, Huo R. Propranolol Treatment for Infantile Hemangiomas: Short-Term Adverse Effects and Follow-Up to Age Two. BioMed Research Int. 2019;2728952:9.

Katona G, Csa´ka´nyi Z, Ga´cs E. Propranolol for infantile haemangioma: striking effect in the first weeks. Int J Pediatr Otorhinolaryngol 2012;76:1746-50.

Qin ZP, Liu XJ, Li KL. Treatment of infantile hemangiomas with low-dose propranolol: evaluation of short-term efficacy and safety. Zhonghua Yi Xue Za Zhi. 2009;89:3130-4.

Li G, Xu DP, Tong S, Xue L, Sun NN, Wang XK. Oral Propranolol with Topical Timolol Maleate Therapy for Mixed Infantile Hemangiomas in Oral and Maxillofacial Regions. J Craniofac Surg. 2016;27(1):56-60.

Qiao J, Lin J, Zhang D, Li J, Chen C, Yu H et al. Efficacy of Combined Topical Timolol and Oral Propranolol for Treating Infantile Hemangioma: A Meta-Analysis of Randomized Controlled Trials. Front Pharmacol. 2020;11:554847.

Gong H, Xu DP, Li YX, Cheng C, Li G, Wang XK. Evaluation of the efficacy and safety of propranolol, timolol maleate, and the combination of the two, in the treatment of superficial infantile haemangiomas. Br J Oral Maxillofac Surg. 2015;53(9):836-40.