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Fractional Carbon Dioxide Laser–Assisted Drug Delivery of Topical Timolol Solution for the Treatment of Deep Infantile Hemangioma: A Pilot Study
Author(s) -
Ma Gang,
Wu Pinru,
Lin Xiaoxi,
Chen Hui,
Hu Xiaojie,
Jin Yunbo,
Qiu Yajing
Publication year - 2014
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.12299
Subject(s) - timolol , medicine , transdermal , carbon dioxide laser , hemangioma , anesthesia , prospective cohort study , infantile hemangioma , intraocular pressure , surgery , pharmacology , laser , laser surgery , physics , optics
Infantile hemangiomas ( IH s) are benign vascular tumors of infancy. Topical timolol has recently been reported to be an effective treatment for superficial IH s, although it failed to have an effect on deep IH s. This prospective study was aimed at evaluating the feasibility of ablative fractional laser–assisted drug delivery for enhancing topical timolol permeation into deep IH s. Nine patients ages 1 to 6 months with deep IH s were enrolled. A fractional carbon dioxide ( CO 2 ) laser system was applied to the skin surface of deep IH s using the D eep F x mode (25–30 mJ/pulse, 5% density, single pulse) at 1‐week intervals. Topical timolol maleate 0.5% ophthalmic solution was applied under occlusion for 30 minutes four to five times per day for an average treatment duration of 14.2 weeks. Clinical improvement was evaluated according to a global score and the Hemangioma Activity Score ( HAS ). Four patients (44.4%) demonstrated excellent regression, four (44.4%) showed good response, and one (11.1%) experienced moderate regression. The HAS declined from 4.1 ± 0.7 at baseline to 1.7 ± 0.7 at 1 week (p < 0.001) and 1.4 ± 0.7 at 3 months (p = 0.03) after the last treatment procedure. Plasma timolol concentration was not detected in any of the patients after the first administration of topical timolol. No systemic complication or skin side effects were observed in any of the patients. Ablative fractional laser–assisted transdermal delivery of topical timolol is a safe and effective method for the treatment of deep IH s.