title: Fractional carbon dioxide laser-assisted drug delivery of topical timolol solution for the treatment of deep infantile hemangioma: a pilot study.
abstract: Infantile hemangiomas (IHs) are benign vascular tumors of infancy. Topical timolol has recently been reported to be an effective treatment for superficial IHs, although it failed to have an effect on deep IHs. This prospective study was aimed at evaluating the feasibility of ablative fractional laser-assisted drug delivery for enhancing topical timolol permeation into deep IHs. Nine patients ages 1 to 6 months with deep IHs were enrolled. A fractional carbon dioxide (CO2 ) laser system was applied to the skin surface of deep IHs using the DeepFx 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 IHs.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, Shanghai, China; Cosmetic Laser Center, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Ma
authors.forename: Pinru
authors.initials: P
authors.lastname: Wu
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Lin
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Xiaojie
authors.initials: X
authors.lastname: Hu
authors.forename: Yunbo
authors.initials: Y
authors.lastname: Jin
authors.forename: Yajing
authors.initials: Y
authors.lastname: Qiu
mesh_terms: D000287:Administration, Topical; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000493:pharmacokinetics; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006391:Hemangioma / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007223:Infant; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D013999:Timolol / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D013999:Timolol