Clinical Evaluation of Efficacy and Safety of Combined Topical Timolol and Oral Propranolol in Children with Infantile Hemangioma

Objective: To evaluate the efficacy and safety of combined topical timolol and oral propranolol in treatment of infantile hemangioma. Patients and Methods: This prospective study was conducted in Basra teaching hospital in Basra, Iraq, where a total of 23 infants with 34 lesions of different types of hemangioma were included. All lesions were in proliferation phase. The infants’ ages were less than one year. They were treated with topical timolol solution 0.5% combined with oral propranolol in a period of 12 weeks (8-16 weeks). The response to treatment was evaluated clinically by using hemangioma score and Visual analogue scale. All infants followed 4-12 months after cessation of drugs. Results: By using hemangioma score system; the combined therapy showed that, 28 (82.4%) lesions showed excellent response, two (5.9%) showed good response, four (11.8%) showed fair response and none of the lesions showed poor response at end of 16 weeks. At the end of 4 months superficial hemangioma showed 100% reduction in their score, while the ulcerative hemangioma showed 94.7% reduction in their score while mixed hemangioma showed only 76.7% reduction in their scores. Complete resolution occurred in 50% of lesions after 4 months of treatment. Neither included infants developed serious side effects nor, any of the regressed hemangioma recur during the follow up. Conclusion: Combined topical Timolol 0.5% solution and oral propranolol seems to be a well-tolerated, safe treatment option with a good to excellent responses. The most responsive type of hemangioma to this combination are the superficial and ulcerative types.