|Year : 2021 | Volume
| Issue : 1 | Page : 65-66
Topical beta-blockers: A noninvasive treatment for pediatric pyogenic granuloma
Pratheeba Devi Nivean1, M Nivean2, Murali Ariga3
1 Department of Ophthalmology, M N Eye Hospital, Chennai, Tamil Nadu, India
2 Retina Consultant, MN Eye Hospital, Chennai, Tamil Nadu, India
3 Department of Ophthalmology, Swamy Eye Hospital, Chennai, Tamil Nadu, India
|Date of Submission||29-Aug-2020|
|Date of Acceptance||13-Jan-2021|
|Date of Web Publication||27-Mar-2021|
Dr. M Nivean
M N Eye Hospital, 781 T H Road, Tondiarpet, Chennai - 600 021, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Ocular pyogenic granulomas (PG) are common benign tumors seen by general ophthalmologists. Topical beta-blockers can be an effective noninvasive treatment for them. It is particularly very useful in the pediatric population where both surgical excision or steroid use can be risky. We present this case to report yet another use of timolol in ophthalmology.
Keywords: Pediatric pyogenic granuloma, pyogenic granuloma, topical timolol
|How to cite this article:|
Nivean PD, Nivean M, Ariga M. Topical beta-blockers: A noninvasive treatment for pediatric pyogenic granuloma. TNOA J Ophthalmic Sci Res 2021;59:65-6
|How to cite this URL:|
Nivean PD, Nivean M, Ariga M. Topical beta-blockers: A noninvasive treatment for pediatric pyogenic granuloma. TNOA J Ophthalmic Sci Res [serial online] 2021 [cited 2021 Apr 22];59:65-6. Available from: https://www.tnoajosr.com/text.asp?2021/59/1/65/312277
| Introduction|| |
Pyogenic granuloma (PG) is a common vascular lesion that develops on cutaneous and mucosal surfaces. It can occur following trauma, surgery, or chalazion. In the eye, it can grow on the palpebral or bulbar conjunctiva, both of which can cause irritation, watering, discharge, and spontaneous bleeding. We report a novel alternative treatment for these lesions with topical beta-blockers.
| Case Report|| |
An 8-year-old boy came to us with complaints of the slowly progressive lesion in his left lower palpebral conjunctiva. His best-corrected vision in both eyes was 6/6; n6, respectively. His anterior segment and fundus examination were within the normal limits. He had a vascular elevated lesion in his left eye lower palpebral conjunctiva near the puncta. No previous treatment was done. He had no systemic complications. Clinically, the lesion was suggestive of PG. We gave him timolol (topical beta-blocker) eye drops to be applied twice daily for 2 weeks. On his review, after 2 weeks, the lesion reduced dramatically. We advised him to use 2 more weeks and stop. On his final review, there was a complete resolution of the lesion [Figure 1]a and [Figure 1]b.
|Figure 1: (a) Slit lamp photography of the lower palpebral conjunctiva showing the pyogenic granuloma. (b) Slit lamp photography of the lower palpebral conj unctiva after treatment with timolol eye drops|
Click here to view
| Discussion|| |
Hypoxia caused by stimulus such as trauma, inflammation, postsurgery increases the vascular endothelial growth factor (EGF) and fibroblast growth factor, which in turn causes the growth of the PG. It can be treated by topical steroids, imiquimod, silver nitrate, cryotherapy, electrocautery, laser therapy, or excision. Topical steroid are commonly used for treating PG. They reduce the inflammation and shrink the lesion. However, it is a double-edged weapon, so it has to be used carefully in children because it can be easily misused.
Topical timolol is a safe drug being currently in use for glaucoma. The efficacy of timolol gel for capillary hemangioma has been well established. The proposed mechanism of action involves vasoconstriction of intralesional blood vessels, leading to inhibition of vascular EGF production and promotion of apoptosis.
The largest retrospective interventional study by lauren et al. has reported 88% resolution of ocular PG using topical timolol 0.5% eye drops 2 times a day. Timolol has the advantage of being noninvasive, requiring no anesthesia and has low side-effect profile when compared to any other treatment. The other indication for the use of topical beta-blockers can be for caruncular PG or lesions medial to puncta. However, Gupta et al. have reported variable response of PG with topical timolol.
We have treated many adult patients also and we noted that the response is good in the majority of cases. There is a poor response only when there is a component of chalazion also. Reported side effects include poor or incomplete clinical response, burning sensation, blurred vision, headache, and weakness. No life-threatening complications have been noted.
There are lot of published literature on the use of timolol gel for cutaneous lesions in many dermatology journals. Newer cancer therapies like the EGF receptor inhibitor therapy has been known to cause PG. Beta-blockers can be an effective noninvasive treatment for the management of PG due to anti-epidermal growth factor receptor cancer therapy.
| Conclusion|| |
Topical timolol is an effective noninvasive modality of treatment for ocular PG. It can be considered as the first line of treatment for PG in children, caruncular lesions and the elderly not willing for surgery or other treatment.
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.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Oke I, Alkharashi M, Petersen RA, Ashenberg A, Shah AS. treatment of ocular pyogenic granuloma with topical timolol. JAMA Ophthalmol 2017;135:383-5.
DeMaria LN, Silverman NK, Shinder R. Ophthalmic pyogenic granulomas treated with topical timolol – Clinical features of 17 cases. Ophthalmic Plast Reconstr Surg 2018;34:579-82.
Wine Lee L, Goff KL, Lam JM. Treatment of pediatric pyo-genic granulomas using β-adrenergic receptor antagonists. Pediatr Dermatol 2014;31:203-7.
Gupta D, Singh N, Thappa DM. Is timolol an effective treatment for pyogenic granuloma? Int J Dermatol 2016;55:592-5.
Segaert S, Van Cutsem E. Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol 2005;16:1425-33.
Piraccini BM, Alessandrini A, Dika E, Starace M, Patrizi A, Neri I. Topical propranolol 1% cream for pyogenic granulomas of the nail: Open-label study in 10 patients. J Eur Acad Dermatol Venereol 2016;30:901-2.