Pulsed dye laser and topical timolol gel versus Pulse dye laser in treatment of infantile hemangioma: A double-blind randomized controlled trial

Authors
Ali Asilian 1
Fatemeh Mokhtari 2
Atefeh Sadat Kamali 3
Bahareh Abtahi-Naeini 2
Mohammad Ali Nilforoushzadeh 4
Shayan Mostafaie 5
1 Department of Dermatology; Skin Diseases and Leishmaniasis Research Center, Tehran University of Medical Sciences, Tehran; Isfahan University of Medical Sciences; Isfahan, Iran
2 Department of Dermatology, Tehran University of Medical Sciences, Tehran; Isfahan University of Medical Sciences; Isfahan, Iran
3 Department of Dermatology; Isfahan University of Medical Sciences; School of Medicine, Tehran University of Medical Sciences; Tehran, Iran
4 Skin Diseases and Leishmaniasis Research Center; Skin and Stem Cell Research Center; Tehran University of Medical Sciences, Tehran, Iran
5 Isfahan University of Medical Sciences; Department of Epidemiology and Biostatistics, School of Public Health, Isfahan, Iran
Abstract
Background: Infantile hemangioma (IH) is the most common tumor during infancy that usually appears as macular and gradually becomes a plaque or tumor. Approximately, 20% of all IH cases results in adverse effects and the Pulsed dye laser (PDL) 585 nm is a vascular laser leading to selective the micro vascular damage. Results of studies on non-selective B-blockers (e.g., timolol) indicate their effectiveness in preventing hemangioma growth. The aim of this study is a comparison of PDL plus timolol and PDL in the treatment of IH.
Materials and Methods: This double-blind study was carried out on 30 infants (1-12 months old) and the patients were divided into two groups. Group A was treated with the four sessions PDL and the timolol gel 0.05% and Group B with PDL.
Results: There were no differences in the mean age of patients for the diagnosis of hemangioma (Group A: 32.69 ± 24.64 days, Group B: 25.69 ± 21.16 days, P = 0.39) and the mean age at the start of the treatment (Group A: 148.125 ± 85.88 days, Group B: 146.25 ± 60.87 days, P = 0.94). There were a statistical difference in the mean of lesion size reduction (Group A: 17.62 ± 6.97 cm and Group B: 12 ± 5.71 cm, P = 0.018), mean percentage change in size mean (Group A: 71079 ± 23.41% and Group B: 54.59 ± 25.46%, P = 0.050) visual analog scale (Group A: 7.19 ± 1.51, Group B: 5.62 ± 1.78, P = 0.012) after treatment. There was no correlation between the time of beginning the treatment and the results (P = 0.857).
Conclusions: Application of timolol with PDL is accompanied by the highest efficacy, cost benefits and the short time of treatment.

Keywords

1.
Kessels JP, Hamers ET, Ostertag JU. Superficial Hemangioma: Pulsed Dye Laser Versus Wait- and-See. Dermatol Surg 2012;26:12081.  Back to cited text no. 1
    
2.
Hemangioma Investigator Group, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, et al. Prospective study of infantile hemangiomas: Demographic, prenatal, and perinatal characteristics. J Pediatr 2007;150:291-4.  Back to cited text no. 2
    
3.
Hoornweg MJ, Smeulders MJ, Ubbink DT, van der Horst CM. The prevalence and risk factors of infantile haemangiomas: A case-control study in the Dutch population. Paediatr Perinat Epidemiol 2012;26:156-62.  Back to cited text no. 3
    
4.
Margileth AM, Museles M. Cutaneous hemangiomas in children. Diagnosis and conservative management. JAMA 1965;194:523-6.  Back to cited text no. 4
    
5.
Chang LC, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, et al. Growth characteristics of infantile hemangiomas: Implications for management. Pediatrics 2008;122:360-7.  Back to cited text no. 5
    
6.
Miller T, Frieden IJ. Hemangiomas: New insights and classification. Pediatr Ann 2005;34:179-87.  Back to cited text no. 6
    
7.
Barry RB, Hughes BR, Cook LJ. Involution of infantile haemangiomas after imiquimod 5% cream. Clin Exp Dermatol 2008;33:446-9.  Back to cited text no. 7
    
8.
Rizzo C, Brightman L, Chapas AM, Hale EK, Cantatore-Francis JL, Bernstein LJ, et al. Outcomes of childhood hemangiomas treated with the pulsed-dye laser with dynamic cooling: A retrospective chart analysis. Dermatol Surg 2009;35:1947-54.  Back to cited text no. 8
    
9.
Awadein A, Fakhry MA. Evaluation of intralesional propranolol for periocular capillary hemangioma. Clin Ophthalmol 2011;5:1135-40.  Back to cited text no. 9
    
10.
Ashinoff R, Geronemus RG. Failure of the flashlamp-pumped pulsed dye laser to prevent progression to deep hemangioma. Pediatr Dermatol 1993;10:77-80.  Back to cited text no. 10
    
11.
Tay YK, Tan SK. Treatment of infantile hemangiomas with the 595-nm pulsed dye laser using different pulse widths in an Asian population. Lasers Surg Med 2012;44:93-6.  Back to cited text no. 11
    
12.
Srinivas CR, Kumaresan M. Lasers for vascular lesions: Standard guidelines of care. Indian J Dermatol Venereol Leprol 2011;77:349-68.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Weissenstein A, Straeter A, Villalon G, Bittmann S. Topical timolol for small infantile hemangioma: A new therapy option. Turk J Pediatr 2012;54:156-8.  Back to cited text no. 13
    
14.
Ho NT, Lansang P, Pope E. Topical imiquimod in the treatment of infantile hemangiomas: A retrospective study. J Am Acad Dermatol 2007;56:63-8.  Back to cited text no. 14
    
15.
Williamson A, Hoggart B. Pain: A review of three commonly used pain rating scales. J Clin Nurs 2005;14:798-804.  Back to cited text no. 15
    
16.
Yu Y, Flint AF, Mulliken JB, Wu JK, Bischoff J. Endothelial progenitor cells in infantile hemangioma. Blood 2004;103:1373-5.  Back to cited text no. 16
    
17.
Frieden IJ, Haggstrom AN, Drolet BA, Mancini AJ, Friedlander SF, Boon L, et al. Infantile hemangiomas: Current knowledge, future directions. Proceedings of a research workshop on infantile hemangiomas, April 7-9, 2005, Bethesda, Maryland, USA. Pediatr Dermatol 2005;22:383-406.  Back to cited text no. 17
    
18.
Khan ZA, Boscolo E, Picard A, Psutka S, Melero-Martin JM, Bartch TC, et al. Multipotential stem cells recapitulate human infantile hemangioma in immunodeficient mice. J Clin Invest 2008;118:2592-9.  Back to cited text no. 18
    
19.
North PE, Waner M, James CA, Mizeracki A, Frieden IJ, Mihm MC. Congenital clinicopathologic infantile hemangioma. Arch Dermatol 2002;137:1607-20.  Back to cited text no. 19
    
20.
Frieden IJ, Eichenfield LF, Esterly NB, Geronemus R, Mallory SB. Guidelines of care for hemangiomas of infancy. American Academy of Dermatology Guidelines/Outcomes Committee. J Am Acad Dermatol 1997;37:631-7.  Back to cited text no. 20
    
21.
Mariwalla K, Dover JS. The use of lasers in the pediatric population. Skin Therapy Lett 2005;10:7-9.  Back to cited text no. 21
    
22.
Moehrle M, Léauté-Labrèze C, Schmidt V, Röcken M, Poets CF, Goelz R. Topical timolol for small hemangiomas of infancy. Pediatr Dermatol 2013;30:245-9.  Back to cited text no. 22
    
23.
Chakkittakandiyil A, Phillips R, Frieden IJ, Siegfried E, Lara-Corrales I, Lam J, et al. Timolol maleate 0.5% or 0.1% gel-forming solution for infantile hemangiomas: A retrospective, multicenter, cohort study. Pediatr Dermatol 2012;29:28-31.  Back to cited text no. 23
    
24.
Batta K, Goodyear HM, Moss C, Williams HC, Hiller L, Waters R. Randomised controlled study of early pulsed dye laser treatment of uncomplicated childhood haemangiomas: Results of a 1-year analysis. Lancet 2002;360:521-7.  Back to cited text no. 24
    
25.
Hunzeker M C, Geronemuf G R. Treatment of infantile hemangioma of the eyelid using the 595 nm pulsed dye laser.J Dermato surg 2010:36:590-7  Back to cited text no. 25
Advanced Biomedical Research
Volume 2015, November
November 2015
Pages 1-6