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LETTER TO EDITOR
Year : 2021  |  Volume : 22  |  Issue : 1  |  Page : 92-93

Ulcerated Infantile Genital Hemangioma Treated with Timolol


Department of Dermatology, Venereology and Leprology, Bhaskar Medical College, Hyderabad, Telangana, India

Date of Submission05-Mar-2020
Date of Decision29-Mar-2020
Date of Acceptance07-May-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Priyanka Mutyala
Flat No. 20068, Tower 20b, Fifth Floor, Prestige Bella Vista, Mount Poonamallee Road, Iyyappanthangal, Chennai - 600 056, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_36_20

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How to cite this article:
Mutyala P, Bommakanti J. Ulcerated Infantile Genital Hemangioma Treated with Timolol. Indian J Paediatr Dermatol 2021;22:92-3

How to cite this URL:
Mutyala P, Bommakanti J. Ulcerated Infantile Genital Hemangioma Treated with Timolol. Indian J Paediatr Dermatol [serial online] 2021 [cited 2021 Jan 16];22:92-3. Available from: https://www.ijpd.in/text.asp?2021/22/1/92/305806



Sir,

Infantile hemangiomas (IHs) are benign vascular tumors which proliferate in the first few months of life and involute over years. Hemangiomas are more common in girls. Ulceration occurs in 20% of cases. IH can be classified morphologically as superficial, deep, mixed, reticular, and focal. Hemangiomas over the genital region are rare.[1]

A 9-month female infant was brought to the OPD with complaints of red, raised lesions over the genitalia from 1 month of age. There was ulceration of the lesion over the left labia majora associated with pain for 1 month. Physical examination revealed four well-defined bright red plaques of size varying from 0.5 cm × 0.5 cm to 5 cm × 4 cm on the right and left side of the labia majora, above the labia majora and vulva, respectively [Figure 1]. Nonindurated ulcer of size 3 cm × 4 cm with well-defined margins and base covered with granulation tissue is present on the labia majora [Figure 2]. No such lesions were found anywhere else in the body. Nails and oral mucosa were normal. All routine investigations were within normal limits. Ultrasonography of the abdomen and spine were normal. The infant was treated with topical antibiotic for ulcer which healed within 2 weeks. Hemangioma was treated with timolol 0.5% drops twice a day 2 drops on each side of the hemangioma applied with a gloved index finger. There was a change in the color of the lesion from bright red to pale red and decrease in protuberance of hemangioma after 2 months of application of 0.5% timolol drops [Figure 3]. IHs represent the most common vascular tumors in infancy with a prevalence of 4%–6%.[2] Lower extremity hemangiomas are very rare. While most IHs tend to resolve spontaneously, some can cause life-threatening complications, undergo painful ulceration, or lead to permanent disfigurement. Propranolol, timolol a nonselective β-blocker, has emerged as an alternative systemic treatment to corticosteroids in the management of hemangioma. Early intervention during the rapid proliferative phase (age 1–6 months) results in better and faster resolution of IHs. Pope and Chakkittakandiyil in their study concluded that topical timolol caused significant shrinkage in the size of the lesions.[3] Chan et al. in their study concluded that timolol maleate gel 0.5% with maximum dose of 0.5 mg/day is a safe, effective option for superficial hemangiomas and resulted in significant color change and reduction in size by >5% when compared to untreated hemangiomas at 20 and 24 weeks.[4] In a study done by George and William, there was significant color change of tongue and perioral superficial hemangioma with ulceration treated with 1–2 drops of 0.5% timolol maleate per application applied 2–5 time a day.[5] We report a rare case of ulcerative type of genital IH, which is responding to treatment with topical timolol drops 0.5% 4 drops per day without any complications.
Figure 1: Ulcerated lesion

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Figure 2: Lesion before treatment

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Figure 3: Lesion after 2 months of treatment with timolol

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We are thankful to the patients and their parents who participated in the study and facilitating the research process.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Griffiths C, Barker J, Bleiker T, Chalmers R. Daniel Creamer. 9th ed. Vol. 3. New Jersey: John Wiley and Sons Ltd.;2016. p. 117.17-22.  Back to cited text no. 1
    
2.
Hoeger PH. An update on infantile haemangiomas. Br J Dermatol 2013;169:11.  Back to cited text no. 2
    
3.
Pope E, Chakkittakandiyil A. Topical timolol gel infantile hemangiomas: A pilot study. Arch Dermatol 2010;146:564-6.  Back to cited text no. 3
    
4.
Chan H, Mckay C, Adams S, Wargon O. RCT of timolol maleate gel for superficial hemangiomas in 5 to 24 weeks old. Am Acad Paediart J 2013;131:1739-47.  Back to cited text no. 4
    
5.
George A, William A. Topical timolol ophthalmic solution causing remarkable improvement in ulcerated facial haemangioma. Indian J Pediatr Dermatol 2016;16:230-2.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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