Diagnosis and Management of Infantile Hemangioma

Table 20. Resolution outcomes in studies comparing timolol and imiquimod
Author, Year
Comparison Groups
(n)
Quality
Qiu et al. 2013 105
G1: Topical imiquimod
5% cream (20)
G2: Topical timolol
ophthalmic 0.5%
solution (20)
Quality: Fair
Age, Months
Type
Age,
mean±SD,
G1: 3.1 ± 1.20
G2: 3.0 ± 1.96
Type, %
Proliferating
superficial
G1+G2: 100
Location
G1+G2:
multiple
Methods and
Measures of
Resolution/Response
• Visual analog scale
(VAS)
• Hemangioma
Activity Score (HAS)
evaluations
conducted by two
study investigators
• Blinded assessment:
NR
Resolution
Outcomes, n
VAS and HAS
results
presented in
figures
VAS
G1 vs.G2
p=0.11
Δ HAS
G1 vs.G2
p=0.49
Rebound
Growth/
Recurrence
Other
Outcomes
G = group; HAS = hemangioma activity score; n = number; NR = not reported; SD = standard deviation; VAS = visual analog
scale
Topical Timolol Versus Laser
One fair quality RCT conducted in Egypt compared topically applied timolol (0.5%
ophthalmic solution) and sequential PDL and Nd:YAG laser in 60 children (age range not clear)
with superficial or mixed IH. 14 Children received treatment for roughly 4 to 5.5 months. Forty
percent of children in the timolol group and 20 percent in the laser group had an excellent
response (defined as improvement of 76-100%), and IH hemoglobin level declined significantly
from baseline in both groups. Improvement in IH in either group did not differ between children
who were greater or less than 6 months of age, but response was greater in superficial lesions
compared with mixed lesions in both groups. More mixed lesions responded to laser than to
timolol, with deep components of superficial lesions not responding to timolol. Superficial
lesions responded more quickly and more extensively to timolol than to laser (p=NR). The study
provided few statistical comparisons of timolol versus laser.
In a poor quality retrospective cohort study comparing topical timolol alone with timolol plus
PDL in 102 children with superficial IH, children received treatment for between 2 and 24
months. 106 Overall, 97 percent of children had improvement in IH (3 children in the timolol arm
had no change, 28 had >75% improvement), with greater improvement in the combination arm
compared with the timolol alone arm (mean global assessment score change of 2.66 vs. 1.88,
p=0.02, score range=-1 to 4 with higher number indicating more improvement). Table 21
outlines key outcomes.
NR
57