Case and Research Letters
Infantile Hemangioma of the Eyelid Treated with Timolol Gel
Hemangioma infantil palpebral tratado con timolol gel
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Vera-Casaño, J. Escudero-Gómez, A. Hiraldo-Gamero" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.D." "apellidos" => "Fernández-Ballesteros" "email" => array:1 [ 0 => "loleballes@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Á." "apellidos" => "Vera-Casaño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Escudero-Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Hiraldo-Gamero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Materno Infantil Carlos Haya, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Materno Infantil Carlos Haya, Málaga, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemangioma infantil palpebral tratado con timolol gel" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 250 "Ancho" => 950 "Tamanyo" => 51129 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Infantile hemangioma of the eyelid after 4<span class="elsevierStyleHsp" style=""></span>months of treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hemangioma is the most common benign tumor in childhood, with a prevalence of 10%<span class="elsevierStyleHsp" style=""></span>to<span class="elsevierStyleHsp" style=""></span>12% in the first year of life.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This vascular tumor appears in the early months of life and has 2<span class="elsevierStyleHsp" style=""></span>phases: a proliferative phase of rapid growth in the first few months, followed by a slow, involuting phase that can last years.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Tumors in certain sites require early treatment to prevent sequelae; for instance, periocular tumors have been associated with complications such as amblyopia, asymmetric astigmatism, proptosis, strabismus, and exposure keratitis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The classic treatment of hemangiomas has essentially been systemic corticosteroids.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Other treatments used are topical and intralesional corticosteroids, laser therapy, surgery, and interferon<span class="elsevierStyleHsp" style=""></span>α<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. In<span class="elsevierStyleHsp" style=""></span>2008 Léaute-Labréze<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> described the treatment of hemangiomas with propanol, which is currently one of the most effective alternatives. In recent years timolol has been successfully used for certain hemangiomas.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,8–10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We describe the case of a 2-month-old preterm infant who, at 2<span class="elsevierStyleHsp" style=""></span>weeks of life, developed a focal hemangioma of infancy on the upper left eyelid; the hemangioma blocked the child's vision and exerted moderate pressure on the eyeball (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient was assessed by the ophthalmology department and other eye conditions were ruled out. Because treatment was needed to prevent complications but the parents declined systemic treatment, timolol<span class="elsevierStyleHsp" style=""></span>0.1% ophthalmic gel was applied twice daily. The gel was instilled into the palpebral conjunctiva by everting the eyelid slightly and applied to the outer surface of the hemangioma. The nasolacrimal duct was then occluded at the punctum to achieve stronger local activity and lower systemic absorption.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The tumor shrunk noticeably in the first week of treatment, leaving the pupillary area free; the proliferative component was also greatly reduced (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). After 4<span class="elsevierStyleHsp" style=""></span>months of treatment, the hemangioma had disappeared almost entirely (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), with no local or systemic adverse events during treatment. By<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>months post-treatment, the hemangioma had not recurred.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Oral propranolol is currently one of the most commonly used drugs used to treat hemangiomas.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Its therapeutic effects are achieved through several mechanisms: vasoconstriction and decreased expression of vascular endothelial growth factor (VEFG) and fibroblast growth factor (bFGF).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Although propranolol is considered safe, its use has been associated with adverse reactions, such as bronchospasm, arrhythmias, bradycardia, hypotension, and hypoglycemia.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,9</span></a> Traditionally, systemic corticoidsteroids have been the first-line treatment for hemangiomas; however, their prolonged use has been associated with adverse effects, including hypertension, glaucoma, myopathy, and decreased weight and height gain.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Other therapeutic alternatives, for instance, intralesional corticosteroids, can cause complications, including deformation of the eyelid, elevated intraocular pressure, and occlusion of the central retinal artery.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Timolol is a noncardioselective beta blocker similar to propranolol. The drug is available is several forms: 0.5%<span class="elsevierStyleHsp" style=""></span>eye drops,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> 0.5%<span class="elsevierStyleHsp" style=""></span>gel<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> (not sold in Spain), and 0.1%<span class="elsevierStyleHsp" style=""></span>gel (used in this case). In this form, the pharmacokinetic data suggest almost no systemic exposure, with plasma concentrations below the quantitation limit (QL<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.8<span class="elsevierStyleHsp" style=""></span>ng/mL). However, the contraindications and adverse effects of systemic beta blockers should be taken into account, although side effects are rarely observed after ocular instillation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Nine cases of palpebral hemangioma treated with timolol have been described to date. The condition was first reported in 2010 by Guo and Ni<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and more recently by Khunger and Pahwa,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> who described a hemifacial hemangioma associated with PHACE (posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities) syndrome, and by Ni<span class="elsevierStyleHsp" style=""></span>et<span class="elsevierStyleHsp" style=""></span>al,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> who published a series of 7<span class="elsevierStyleHsp" style=""></span>cases. All of these authors reported satisfactory outcomes. However, in the 2010 study by Guo<span class="elsevierStyleHsp" style=""></span>and<span class="elsevierStyleHsp" style=""></span>Ni<span class="elsevierStyleSup">3</span> and the 7<span class="elsevierStyleHsp" style=""></span>cases reported subsequently by Ni<span class="elsevierStyleHsp" style=""></span>et<span class="elsevierStyleHsp" style=""></span>al,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> response to treatment was slower than in our patient, occurring 4<span class="elsevierStyleHsp" style=""></span>to<span class="elsevierStyleHsp" style=""></span>5 weeks after start of treatment. This difference may be attributable to the fact that we used a gel formulation and also applied the drug to the conjunctival surface.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In our case, timolol gel<span class="elsevierStyleHsp" style=""></span>0.1% was shown to be a safe and effective treatment and we believe that its use at certain sites, such as the periocular region, could be an effective option that should be considered when systemic treatment is contraindicated.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Fernández- Ballesteros MD, et al. Hemangioma infantil palpebral tratado con timolol gel. Actas Dermosifiliogr.2012;103:444-6.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 281 "Ancho" => 950 "Tamanyo" => 44897 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Infantile hemangioma of the eyelid before treatment.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 299 "Ancho" => 950 "Tamanyo" => 54335 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Infantile hemangioma of the eyelid after 1<span class="elsevierStyleHsp" style=""></span>week of treatment.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 250 "Ancho" => 950 "Tamanyo" => 51129 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Infantile hemangioma of the eyelid after 4<span class="elsevierStyleHsp" style=""></span>months of treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemangiomas of infancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 14 | 13 | 27 |
| 2024 Octubre | 168 | 60 | 228 |
| 2024 Septiembre | 168 | 32 | 200 |
| 2024 Agosto | 195 | 89 | 284 |
| 2024 Julio | 192 | 46 | 238 |
| 2024 Junio | 183 | 46 | 229 |
| 2024 Mayo | 142 | 35 | 177 |
| 2024 Abril | 150 | 36 | 186 |
| 2024 Marzo | 150 | 31 | 181 |
| 2024 Febrero | 235 | 32 | 267 |
| 2024 Enero | 175 | 37 | 212 |
| 2023 Diciembre | 192 | 29 | 221 |
| 2023 Noviembre | 174 | 30 | 204 |
| 2023 Octubre | 161 | 45 | 206 |
| 2023 Septiembre | 199 | 33 | 232 |
| 2023 Agosto | 150 | 18 | 168 |
| 2023 Julio | 201 | 46 | 247 |
| 2023 Junio | 173 | 32 | 205 |
| 2023 Mayo | 215 | 32 | 247 |
| 2023 Abril | 155 | 20 | 175 |
| 2023 Marzo | 197 | 34 | 231 |
| 2023 Febrero | 153 | 28 | 181 |
| 2023 Enero | 78 | 30 | 108 |
| 2022 Diciembre | 61 | 49 | 110 |
| 2022 Noviembre | 27 | 43 | 70 |
| 2022 Octubre | 49 | 24 | 73 |
| 2022 Septiembre | 26 | 35 | 61 |
| 2022 Agosto | 23 | 38 | 61 |
| 2022 Julio | 21 | 38 | 59 |
| 2022 Junio | 26 | 26 | 52 |
| 2022 Mayo | 103 | 33 | 136 |
| 2022 Abril | 158 | 47 | 205 |
| 2022 Marzo | 159 | 61 | 220 |
| 2022 Febrero | 138 | 33 | 171 |
| 2022 Enero | 151 | 53 | 204 |
| 2021 Diciembre | 104 | 39 | 143 |
| 2021 Noviembre | 107 | 48 | 155 |
| 2021 Octubre | 99 | 61 | 160 |
| 2021 Septiembre | 94 | 50 | 144 |
| 2021 Agosto | 99 | 41 | 140 |
| 2021 Julio | 95 | 38 | 133 |
| 2021 Junio | 108 | 27 | 135 |
| 2021 Mayo | 99 | 63 | 162 |
| 2021 Abril | 258 | 87 | 345 |
| 2021 Marzo | 126 | 37 | 163 |
| 2021 Febrero | 73 | 46 | 119 |
| 2021 Enero | 68 | 28 | 96 |
| 2020 Diciembre | 69 | 28 | 97 |
| 2020 Noviembre | 44 | 39 | 83 |
| 2020 Octubre | 57 | 29 | 86 |
| 2020 Septiembre | 44 | 15 | 59 |
| 2020 Agosto | 30 | 23 | 53 |
| 2020 Julio | 37 | 17 | 54 |
| 2020 Junio | 35 | 24 | 59 |
| 2020 Mayo | 25 | 19 | 44 |
| 2020 Abril | 30 | 24 | 54 |
| 2020 Marzo | 27 | 23 | 50 |
| 2020 Febrero | 6 | 6 | 12 |
| 2020 Enero | 4 | 9 | 13 |
| 2019 Diciembre | 8 | 9 | 17 |
| 2019 Noviembre | 4 | 9 | 13 |
| 2019 Octubre | 0 | 6 | 6 |
| 2019 Septiembre | 10 | 9 | 19 |
| 2019 Agosto | 4 | 5 | 9 |
| 2019 Julio | 4 | 17 | 21 |
| 2019 Junio | 4 | 27 | 31 |
| 2019 Mayo | 6 | 43 | 49 |
| 2019 Abril | 2 | 51 | 53 |
| 2019 Marzo | 0 | 17 | 17 |
| 2019 Febrero | 4 | 10 | 14 |
| 2019 Enero | 0 | 4 | 4 |
| 2018 Diciembre | 3 | 6 | 9 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 5 | 6 | 11 |
| 2018 Agosto | 0 | 3 | 3 |
| 2018 Julio | 0 | 5 | 5 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 2 | 2 |
| 2018 Marzo | 10 | 8 | 18 |
| 2018 Febrero | 123 | 7 | 130 |
| 2018 Enero | 148 | 9 | 157 |
| 2017 Diciembre | 137 | 11 | 148 |
| 2017 Noviembre | 125 | 15 | 140 |
| 2017 Octubre | 138 | 9 | 147 |
| 2017 Septiembre | 157 | 17 | 174 |
| 2017 Agosto | 111 | 18 | 129 |
| 2017 Julio | 134 | 14 | 148 |
| 2017 Junio | 138 | 35 | 173 |
| 2017 Mayo | 175 | 22 | 197 |
| 2017 Abril | 90 | 13 | 103 |
| 2017 Marzo | 142 | 30 | 172 |
| 2017 Febrero | 260 | 19 | 279 |
| 2017 Enero | 95 | 17 | 112 |
| 2016 Diciembre | 134 | 15 | 149 |
| 2016 Noviembre | 227 | 28 | 255 |
| 2016 Octubre | 212 | 15 | 227 |
| 2016 Septiembre | 298 | 25 | 323 |
| 2016 Agosto | 305 | 18 | 323 |
| 2016 Julio | 115 | 11 | 126 |
| 2016 Junio | 17 | 19 | 36 |
| 2016 Mayo | 10 | 15 | 25 |
| 2016 Abril | 2 | 24 | 26 |
| 2016 Marzo | 7 | 14 | 21 |
| 2016 Febrero | 5 | 17 | 22 |
| 2016 Enero | 3 | 16 | 19 |
| 2015 Diciembre | 16 | 1 | 17 |
| 2015 Noviembre | 48 | 10 | 58 |
| 2015 Octubre | 64 | 12 | 76 |
| 2015 Septiembre | 43 | 1 | 44 |
| 2015 Agosto | 30 | 6 | 36 |
| 2015 Julio | 169 | 13 | 182 |
| 2015 Junio | 122 | 9 | 131 |
| 2015 Mayo | 143 | 19 | 162 |
| 2015 Abril | 129 | 10 | 139 |
| 2015 Marzo | 179 | 13 | 192 |
| 2015 Febrero | 173 | 19 | 192 |
| 2015 Enero | 107 | 22 | 129 |
| 2014 Diciembre | 124 | 12 | 136 |
| 2014 Noviembre | 82 | 16 | 98 |
| 2014 Octubre | 119 | 15 | 134 |
| 2014 Septiembre | 85 | 10 | 95 |
| 2014 Agosto | 110 | 14 | 124 |
| 2014 Julio | 112 | 18 | 130 |
| 2014 Junio | 138 | 13 | 151 |
| 2014 Mayo | 93 | 9 | 102 |
| 2014 Abril | 75 | 7 | 82 |
| 2014 Marzo | 87 | 20 | 107 |
| 2014 Febrero | 55 | 16 | 71 |
| 2014 Enero | 72 | 9 | 81 |
| 2013 Diciembre | 56 | 8 | 64 |
| 2013 Noviembre | 64 | 16 | 80 |
| 2013 Octubre | 37 | 9 | 46 |
| 2013 Septiembre | 60 | 11 | 71 |
| 2013 Agosto | 40 | 29 | 69 |
| 2013 Julio | 38 | 25 | 63 |
| 2013 Junio | 24 | 28 | 52 |
| 2013 Mayo | 21 | 19 | 40 |
| 2013 Abril | 16 | 38 | 54 |
| 2013 Marzo | 18 | 27 | 45 |
| 2013 Febrero | 44 | 4 | 48 |
| 2013 Enero | 80 | 6 | 86 |
| 2012 Diciembre | 26 | 7 | 33 |
| 2012 Noviembre | 1 | 1 | 2 |
| 2012 Octubre | 0 | 3 | 3 |
| 2012 Agosto | 2 | 1 | 3 |
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