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Hemangioma Research Paper

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PAS 661 Pediatrics EBM Assignment Elizabeth Arnold 6/29/15 Clinical Question: Does topical timolol have the same efficacy in treatment of superficial infantile hemangiomas compared to oral propranolol? Introduction: Infantile hemangioma (IH), a benign vascular tumor, is the most common tumor of infancy, with an incidence of 5%–10% at the end of the first year (1). Most lesions are not visible at birth but appear in the first four to six weeks of life. Hemangiomas are characterized by a growth phase which continues for the first year followed by a involution phase lasting from one to nine years (1). Risk factors for development of hemangiomas are being female, Caucasian, low birth weight, and those of multiple gestations (1). The cause …show more content…

Although there are no FDA-approved treatments for IH, corticosteroids have been the first-line agents for systemic treatment for many years. Oral propranolol, a nonselective beta-blocker, has emerged as an alternative to corticosteroids for treatment of high-risk hemangiomas(2), although both of these treatments may have significant systemic effects(3). Topical timolol malate gel has also shown efficacy and tolerability showing gradual improvement with longer treatment in patients with superficial IH …show more content…

One of them being that it was a randomized controlled trial which increases its internal and external validity. One of the main limitations of the study was the heterogeneous patient population and small numbers. The dramatic response of IH’s to propranolol is encouraging and suggests early treatment could result in decreased scarring and disfigurement. Propranolol hydrochloride administered orally reduced the volume, color, and elevation of focal and segmental IH in infants younger than 6 months up to 5 years of age. LOE II: Evidence obtained from at least one well-designed Randomized Controlled Trial (4). The main strength in the study completed by Chakkittakandiyil et al. was that it demonstrated further clinical evidence of the safety and efficacy of topical timolol maleate. The study had several limitations. The procedures for digital photography were not uniformly standardized and the investigators were not blinded to duration of treatment. Topical timolol was shown to be an effective treatment for superficial IH with decreased risk of adverse events compared to oral beta-blockers. LOE IV: Evidence from well-designed case-control and cohort studies

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