Comparison of oral Propranolol with topical Timolol in the treatment of Superficial Infantile Hemangiomas.

Background: Infantile Hemangiomas (IHs) are common, benign and self-limiting vascular malformations. A significant percent of these vascular lesions are associated with substantial morbidity and cosmetic disfigurement, therefore treatment should be initiated as soon the diagnosis is confirmed especially for the hemangiomas involving vital areas [1]. Oral propranolol has now been a time tested drug for the successful management of superficial IHs; but factors like risk of hypoglycemia, contraindication among babies suffering from allergic respiratory conditions and non-compliance in disfavor its usage in certain children [2]. Topical timolol suits well in these patients as the action is mainly localized at the site of its application. The present study was designed to compare efficacy of these two drug modalities in the treatment of superficial infantile hemangiomas. Patients and methods: This randomized controlled study included 20 children in two groups receiving either oral propranolol or topical timolol. Clinical parameters in the form of systolic and diastolic blood pressure (SBP & DBP), heart rate (HR), respiratory rate (RR), random blood sugar (RBS), oxygen saturation (SaO₂), haemangioma activity score (HAS) & physician global assessment scale (PGA) were recorded and compared well in both the groups till eighteen months. Results: The groups were statistically comparable with respect to the age, sex, gestational age, birth weight and severity of the vascular lesion. Head and neck regions were most commonly involved sites. Both propranolol and timolol were found to be safe and comparable with regard to the changes in HR, respiration pattern and blood sugar levels. However, slightly low DBP was observed in the propranolol group at 20^th week when compared with timolol group (p value- 0.007). On clinical analysis, fall in HAS was significantly lower in propranolol treated babies from 20^th week onwards. The gain in the PGA score was more in propranolol patients and the difference was statistically significant particularly at 18 months (p value- 0.04). Conclusion: We conclude that both the treatment modalities can be administered safely. However, oral propranolol offers better results than topical timolol in terms of clinical response as a whole. [ABSTRACT FROM AUTHOR]