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|Year : 2012 | Volume
| Issue : 2 | Page : 163-165
Topical ophthalmic solution in infantile hemangioma
AK Jha, SK Mallik, M Raihan
Department Of Dermatology, Venereology and Leprosy, Katihar Medical College and Hospital, Katihar, Bihar, India
|Date of Web Publication||14-Jun-2012|
A K Jha
Department Of Dermatology, Venereology and Leprosy, Katihar Medical College and Hospital, Katihar, Bihar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jha A K, Mallik S K, Raihan M. Topical ophthalmic solution in infantile hemangioma. J Postgrad Med 2012;58:163-5
A six-month-old male child presented with a hemangioma involving the left part of the face and upper lip [Figure 1] since birth which was progressively increasing in size. The delivery was uncomplicated. The child was feeding well and gaining weight. Complete hemogram was done and blood count was within normal limits and no other systemic involvement was observed. The diagnosis of superficial infantile hemangioma was made clinically, further confirmed by local ultrasonography. The patient was started on timolol maleate (0.5% ophthalmic solution) 0.5 ml to be applied twice daily on the lesion. After three weeks of topical therapy there was a dramatic response with substantial reduction of size, thickness and color in the initial lesion [Figure 2]. At the five weeks' follow-up visit the result was even better [Figure 3].
There was no side-effect on application of the drug.
Infantile hemangioma is the most common benign vascular tumor of childhood. It is composed of endothelial cells characterized by proliferative phase and as lower involution phase.  The rate of involution for infantile hemangioma has been estimated as 10% every year, which could last for 10 years. The term haima is derived from Greek, meaning blood and angioma, meaning all vascular anomalies.  A classification system by Mulliken and Glowacki was revised in 1996 by the International Society for the Study of Vascular Anomalies.  GLUT-1 has been identified as the immunohistochemical marker of infantile hemangioma, regardless of the stage and in the microvasculature of the placenta. They also share vascular antigens, lewis Y antigen and Merosin, proliferating infantile hemangioma express CD31, CD34 markers for endothelial cells and CD133 expressed in primitive cell population. 
The response to propranolol has been reported by Leaute-labreze et al.  Investigators serendipitously discovered that propanolol effectively treated hemangiomas in two infants who received the drug for cardiac complications while on corticosteroid therapy. Topical timolol has been tried in infantile hemangioma.  Use of beta blocker causes vasoconstriction, change in color, decreased expression of VEGF and bFGF genes through down-regulation of the RAF/mitogen-activated protein kinase pathway.  High-potency topical steroids and topical imiquimod have been tried but they have significant side-effects like local atrophy with steroid, and edema, local itching, peeling, erosion, crusting, ulceration, and scarring with imiquimod. Laser is an option but the cost and availability in the periphery is definitely an issue along with pain, scarring, hypopigmentation and ulceration as side-effects .
Since some cases of infantile hemangiomas that complete involute and may exhibit cutaneous residua, so a continuous follow-up of the patient was done for the past two months. Our case was decided on with non-active intervention at first, however, the size of the lesion was progressively increasing, and based on factors including the size, location, psychosocial complication mainly parents anxiety and rapid increase the treatment was started with topical timolol. The success in reducing the size of the lesion after infantile hemangioma treatment in our case was confirmed clinically supported on local by ultrasonography and clinical photographs, although a visual analogue scale method can also be used.  No side-effects like allergic reaction, erythema, bradycardia were noted. We report this case because the use of topical timolol is a cost-effective and safer alternative treatment and future promising drug in the treatment of infantile hemangioma, however, large-scale studies are needed to establish this.
| :: Acknowledgement|| |
The authors would like to thank the parents of the baby, who allowed us to use clinical photographs and data for publication.
| :: References|| |
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|2.||Mendiratta V, Jabeen M. Infantile hemangioma: An update. Indian J Dermatol Venereol Leprol 2010;76:469-75. |
|3.||Jadhav VM, Tolat SN. Dramatic response of propranolol in hemangioma: Report of two cases. Indian J Dermatol Venereol Leprol 2010;76;691-4. |
|4.||Pope E, Chakkittakandiyil A. Topical timolol gel for infantile hemangioma: A pilot study. Arch Dermatol 2010;146:564-5. |
|5.||D'Angelo G, Lee H, Weiner RI. cAMP-dependent protein kinase inhibits the mitogenic action of vascular endothelial growth factor and fibroblast growth factor in capillary endothelial cells by blocking Raf activation. J Cell Biochem 1997;67:353-66. |
[Figure 1], [Figure 2], [Figure 3]
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