Gökçe Pınar REİS, Ali FETTAH, Ali AKYİĞİT, Atilla ÇAYIR, Burcu VOLKAN

İnfantil hemanjiomların tedavisinde topikal beta-blokerlerin etkinliği

ÖZET Amaç: İnfantil hemanjiomlar (İH) endotel hücrelerinin benign proliferasyonlarıdır. Çocukluk çağının en sık görülen benign tümörleridir. İH’ın çoğu kendiliğinden gerilerken, yaklaşık %10'u medikal tedavi gerektirir. İH’ın medikal tedavisinde kortikosteroidler, interferon ve vinkristin eskiden beri kullanılan ajanlardır. Son yıllarda topikal beta-blokörler teröpatik etkinliklerinin gösterilmesi ve sistemik yan etkilerin daha az görülmesi nedeniyle IH tedavisinde alternatif bir tedavi yöntemi olarak kullanılmaya başlanmıştır. Bu çalışmada, topikal beta-bloker kullanılan yüzeyel İH hastalarının epidemiyolojik özellikleri ve tedavi etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Erzurum Bölge Eğitim ve Araştırma Hastanesi Çocuk Hematoloji-Onkoloji polikliniğine Nisan 2015 ile Mayıs 2017 tarihleri arasında başvuran, yaşları 0-36 ay arasında olan 30 hasta çalışmaya dahil edildi. Yüzeyel hemanjiyomu olan hastalara lezyon bölgesine %0,5 timolol maleate solüsyon, sabah ve akşam ikişer damla olacak şekilde uygulandı. Bulgular: Tedavi öncesi hemanjiomların çapı ortalama 2,5 ± 1,5 cm iken, tedavi sonrası 1,3 ± 0,8 cm olarak belirlendi (p<0,0001). Sonuç: Lezyonda belirgin gerilemeye yol açması nedeni ile timolol kullanımı ümit vadetmektedir. Ancak daha geniş çaplı ve kontrollü-randomize çalışmalara ihtiyaç olduğu da bir gerçektir. ABSTRACT Aim: Infantile hemangiomas are benign proliferation of endothelial cells. It is the most common benign tumor of childhood. Most of the IH is spontaneously regressing, and about 10% requires medical treatment. Corticosteroids, interferon and vincristine have long been used in medical treatment of IH. In recent years, topical beta-blockers have been used as an alternative treatment modality for the treatment of IH because of their therapeutic efficacy and low systemic side effects. The aim of this study was to evaluate the epidemiological features and treatment efficacy of superficial IH patients using topical beta-blockers. Materials and Methods: For this purpose, 30 patients, aged between 0-36 months, who applied to the Pediatric Hematology-Oncology Polyclinic of the Erzurum Regional Education and Research Hospital between April 2015 and May 2017 were included in the study. In patients with superficial hemangioma, 0,5 % timolol maleate solution was applied to the lesion area, two drops in the morning and in the evening. Results: The mean diameter of the hemangiomas before treatment was 2.5 ± 1.5 cm and 1.3 ± 0.8 cm after the treatment. (P<0,0001). Conclusıons: The use of timolol is promising because it causes a marked regression in the lesion. However, it is a fact that wider-scale and controlled-randomized studies are needed. Key words: hemangioma, treatment

Anahtar Kelimeler:

hemanjiom, lokal, tedavi

The efficacy of topical B-blockers in the treatment of infantile hemangiomas

AbstractPurpose: Infantile hemangiomas are benign proliferation of endothelial cells. It is the most common benigntumor of childhood. While the most of IH is spontaneously regressing, about 10% requires medical treatment.Corticosteroids, interferon and vincristine have long been used in medical treatment of IH. In recent years,topical beta-blockers have been used as an alternative treatment modality for the treatment of IH because oftheir therapeutic efficacy and low systemic side effects. The aim of this study was to evaluate the epidemiologicalfeatures and treatment efficacy of superficial IH patients using topical beta-blockers.Materials and methods: 30 patients, aged between 0-36 months, who applied to the Pediatric HematologyOncology Polyclinic of the Erzurum Regional Education and Research Hospital between April 2015 and May2017 were included in the study. In patients with superficial hemangioma, 0.5% timolol maleate solution wasapplied to the lesion area, two drops in the morning and in the evening.Results: While the mean diameter of hemangiomas before treatment was 2.5±1.5 cm, it was determined as1.3±0.8 cm after treatment (p<0,0001).Conclusions: The use of timolol is promising because it causes a marked regression in the lesion. However, itis a fact that wider-scale and controlled-randomized studies are needed.

Keywords:

Hemangioma, local, treatment,

PDF

___

Kaynaklar 1. Drolet BA, Swanson EA, Frieden IJ. Infantile hemangiomas: an emerging health issue linked to an increased rate of low birth weight infants. J Pediatr 2008;153:712–715. https://doi.org/10.1016/j.jpeds.2008.05.043
2. George A, Mani V, Noufal A. Update on the classification of hemangioma. J Oral Maxillofac Pathol 2014;18:117-120. https://doi.org/10.4103/0973-029X.141321
3. Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in children. N Engl J Med 1999;341:173-181.https://doi.org/10.1056/NEJM199907153410307
4. Itinteang T, Withers AHJ, Davis PF, Tan ST. Biology of infantile hemangioma. Front Surg 2014;1-38. https://doi.org/10.3389/fsurg.2014.00038
5. Li J, Chen X, Zhao S, et al. Demographic and clinical characteristics and risk factors for infantile hemangioma: a Chinese case-control study. Arch Dermatol.2011;147:1049-1056. https://doi.org/10.1001/archdermatol.2011.122
6. Haggstrom AN, Drolet BA, Baselga E, et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr 2007;150: 291–294. https://doi.org/10.1016/j.jpeds.2006.12.003
7. Cheng CE, Friedlander SF. Infantile hemangiomas, complications and treatments. Semin Cutan Med Surg 2016;35:108-116. https://doi.org/10.12788/j.sder.2016.050
8. Zhang Q, Chantasart D, Li SK. Evaluation of beta-blocker gel and effect of dosing volüm efor topical delivery. J Pharm Sci 2015;104:1721-1731. https://doi.org/10.1002/jps.24390
9. Xue K, Hildebrand GD. Deep periocular infantile capillary hemangiomas responding to topical application of timolol maleate, 0.5%, drops. JAMA Ophthalmol. 2013;131:1246-1248. https://doi.org/10.1001/jamaophthalmol
10. Painter SL, Hildebrand GD. Review of topical beta blockers as treatment for infantile hemangiomas. Surv Ophthalmol 2016;61:51-58.https://doi.org/10.1016/j.survophthal.2015.08.006
11. Greenberger S, Bischoff J.: Pathogenesis of infantile haemangioma. Br J Dermatol 2013;169:12-19. https://doi.org/10.1111/bjd.12435
12. Xu G, Lv R, Zhao Z, Huo R.: Topical propranolol for treatment of superficial infantile hemangiomas. J Am Acad Dermatol 2012;67:1210-1213.https://doi.org/10.1016/j.jaad.2012.03.009
13.Yu L, Li S, Su B, et al. Treatment of superficial infantile hemangiomas with timolol: evaluation of short-term efficacy and safety in infants. Exp Ther Med 2013;6:388-390. https://doi.org/10.3892/etm.2013.1176
14. Janmohamed SR, Madern GC, de Laat PC, Oranje AP. Educational paper: pathogenesis of infantile haemangioma, an update 2014 (part I). Eur J Pediatr 2015; 97–103. https://doi.org/10.1007/s00431-014-2403-6
15. Chim H, Armijo BS, Miller E, Gliniak C, Serret MA, Gosain AK.: Propranolol induces regression of hemangioma cell sthrough HIF- 1 alpha-mediated inhibition of VEGF-A. Ann Surg 2012;256:146–156. https://doi.org/10.1097/SLA.0b013e318254ce7a
16. Chakkittakandiyil A, Phillips R, Frieden IJ, et al Timolol maleate 0.5% or 0.1% gel-forming solution for infantile hemangiomas: a retrospective, multicenter, cohortstudy. Pediatr Dermatol 2012;29:28–31. https://doi.org/10.1111/j.1525-1470.2011.01664.x
17. Khunger N, Pahwa M. Dramatic response to topical timolol lotion of a large hemifacial infantile haemangioma associated with PHACE syndrome. Br J Dermatol. 2011;164:886-888. https://doi.org/10.1111/j.1365-2133.2010.10177.x
18. Ariwibowo L, Danarti R. Comparison of efficacy between topical corticosteroid, timolol maleat 0.5% eye drop, and education observation in managing infantile hemangioma. Regional Conference of Dermatology (Asian Australasian) and 6th Annual Meeting of the Asian Academy of Dermatology and Venereology (abstract). Danang, 2014.