Zeitschrift für klinische und experimentelle Dermatologieforschung
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Novel Combination Topical Timolol and Pulsed Dye Laser Therapy for Early Effective Safe Treatment of Infantile Hemangiomas

Chun-Shin Chang, Gavin Chun-Wui Kang

Introduction: Infantile Hemangiomas (IH) are the most common benign pediatric tumors and carry potential cosmetic and functional sequelae. Topical timolol and Pulsed Dye Laser (PDL) are effective IH therapies and previous studies have suggested the superiority of combination timolol-PDL therapy for IH over timolol alone. We present our experience using combination timolol and PDL therapy for IH, postulate a synergistic effect, and analyze the impact of age on outcomes.
Method: Sixteen consecutive children with superficial IH were treated with topical 0.5% timolol. Fourteen responded poorly to one month of timolol-alone treatment and were started on concurrent monthly 595 nm PDL treatment. Outcome was scored at 3 months using a Visual Analog Scale (VAS): 4 for excellent (76-100% improvement), 3 for good (51-75%), 2 for moderate (26-50%), 1 for poor (0-25%).
Result: Two patients on timolol alone had excellent response. The rest on combination timolol-PDL therapy were aged 9.6 months on average at initiation of treatment, with mean treatment duration of 4.9 months and a mean 14.3 months follow-up. Treatment was effective in all patients; mean VAS was respectively 3.69 and 3.58 for those younger than 7 months and those older at treatment initiation. Those started on combined treatment before 7 months and who achieved complete IH regression did so within an average 4.6 months and before turning one, compared with the average 11 months for patients started older (p=0.042). One had hyperpigmentation after IH regression. There were no other systemic or local complications.
Conclusion: Early first-line topical timolol treatment for superficial IH combined with 595 nm PDL when indicated, seems safe, simple, and appears to promote fast complete regression with high patient satisfaction making it a good active non-surgical treatment option as opposed to passive waiting. Treatment should ideally start before 7 months of age.