title: Local administration of β-blockers for infantile hemangiomas: a systematic review and meta-analysis.
abstract: BACKGROUND
  Infantile hemangiomas (IHs) are a common pediatric lesion. Orally administered β-blockers have been reported as effective in treating these lesions. However, oral administration is also associated with systemic adverse effects. Treatment with locally administered β-blockers may provide acceptable efficacy with lower incidence of adverse effects. This may offer a better first-line treatment.
  
  
  METHODS
  PubMed was searched through March 2014 for studies reporting patient-level response of 5 or more patients treated with intralesional propranolol, topical timolol, or topical propranolol for cutaneous IHs. Rates of response to treatment, defined as clinically significant regression, were combined using random-effects meta-analysis.
  
  
  RESULTS
  Ninety-four articles were identified. Seventeen articles met the study criteria. These studies primarily focused on superficial IHs. Response rates for topical propranolol and topical timolol were not significantly different, 76% [95% confidence interval (CI), 62%-86%] and 83% (95% CI, 65%-93%), respectively (P=0.45). Prospectively conducted studies reported lower response rates compared to retrospective studies for both topical propranolol (P=0.06) and topical timolol (P<0.01). When only prospectively conducted studies were included, response rates for topical propranolol and topical timolol were not significantly different, 72% (95% CI, 57%-83%) and 72% (95% CI, 53%-86%), respectively (P=0.98). Significant adverse effects were rare. Only 1 case of sleep disturbance was reported across 554 patients from all studies.
  
  
  CONCLUSIONS
  Topically administered β-blockers are an effective treatment for superficial IHs that pose few adverse effects and should be considered for primary treatment.
authors.affiliation: From the *Division of Plastic, Aesthetic and Reconstructive Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami, Leonard Miller School of Medicine, Miami, FL; and †Department of Orthopaedic Surgery, University of Chicago Medical Center, Chicago, IL.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Ovadia
authors.forename: David C
authors.initials: DC
authors.lastname: Landy
authors.forename: Erin R
authors.initials: ER
authors.lastname: Cohen
authors.forename: Ethan Y
authors.initials: EY
authors.lastname: Yang
authors.forename: Seth R
authors.initials: SR
authors.lastname: Thaller
mesh_terms: D000279:Administration, Cutaneous; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D018324:Hemangioma, Capillary / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D015233:Models, Statistical; D011433:Propranolol / Q000008:administration & dosage* / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy*; D013999:Timolol / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D013999:Timolol; D011433:Propranolol