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Local Administration of β-Blockers for Infantile Hemangiomas

A Systematic Review and Meta-analysis

Ovadia, Steven A. MD*; Landy, David C. MD, PhD; Cohen, Erin R. BS*; Yang, Ethan Y. MS*; Thaller, Seth R. MD, DMD, FACS*

doi: 10.1097/SAP.0000000000000390
Review Articles
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Background Infantile hemangiomas (IHs) are a common pediatric lesion. Orally administered β-blockers have been reported as effective in treating these lesions. However, oral administration is also associated with systemic adverse effects. Treatment with locally administered β-blockers may provide acceptable efficacy with lower incidence of adverse effects. This may offer a better first-line treatment.

Methods PubMed was searched through March 2014 for studies reporting patient-level response of 5 or more patients treated with intralesional propranolol, topical timolol, or topical propranolol for cutaneous IHs. Rates of response to treatment, defined as clinically significant regression, were combined using random-effects meta-analysis.

Results Ninety-four articles were identified. Seventeen articles met the study criteria. These studies primarily focused on superficial IHs. Response rates for topical propranolol and topical timolol were not significantly different, 76% [95% confidence interval (CI), 62%–86%] and 83% (95% CI, 65%–93%), respectively (P = 0.45). Prospectively conducted studies reported lower response rates compared to retrospective studies for both topical propranolol (P = 0.06) and topical timolol (P < 0.01). When only prospectively conducted studies were included, response rates for topical propranolol and topical timolol were not significantly different, 72% (95% CI, 57%–83%) and 72% (95% CI, 53%–86%), respectively (P = 0.98). Significant adverse effects were rare. Only 1 case of sleep disturbance was reported across 554 patients from all studies.

Conclusions Topically administered β-blockers are an effective treatment for superficial IHs that pose few adverse effects and should be considered for primary treatment.

From the *Division of Plastic, Aesthetic and Reconstructive Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami, Leonard Miller School of Medicine, Miami, FL; and †Department of Orthopaedic Surgery, University of Chicago Medical Center, Chicago, IL.

Received June 10, 2014, and accepted for publication, after revision, October 16, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: Seth R. Thaller, MD, DMD, FACS, Division of Plastic, Aesthetic and Reconstructive Surgery, DeWitt-Daughtry Family Department of Surgery, University Of Miami, Leonard Miller School of Medicine, Clinical Research Building, 1120 NW 14th St, Room 410, Miami, FL 33136. E-mail: sthaller@med.miami.edu.

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