Topical timolol reduces facial angiofibromas in tuberous sclerosis

Topical beta-blockers could be an alternative to rapamycin for the treatment of angiofibromas after traditional destructive procedures such as ablative laser resurfacing, according to a case study published in the Aug. 24 edition of Pediatrics.

A 26-year-old woman with tuberous sclerosis complex had her facial angiofibromas treated with ablative fractional laser resurfacing and pulsed-dye laser, with topical timolol 0.5% gel applied to one side of her face twice a day for 2 weeks presurgery and from day 5 after surgery.

At 4 months, there was markedly reduced erythema, and a reduced number and size of angiofibromas on the timolol-treated cheek, compared with the untreated cheek (Pediatrics 2015 Aug 24. [doi: 10.1542/peds.2015-0025]).

“Because angiofibromas are known to contain a highly vascular component expressing angiogenic factors such as VEGF [vascular endothelial growth factor], it is likely the patient’s right cheek improved due to the antiangiogenic and proapoptotic effects of the topically administered beta-blocker,” wrote Dr. Andrew C. Krakowski of the University of California, San Diego, and Tuyet A. Nguyen of the Rady Children’s Hospital, San Diego.

An ideal treatment for angiofibromas remains elusive, with destructive treatments such as cryotherapy, dermabrasion, and radiofrequency or laser ablation associated with complications such as pain, postoperative hyperpigmentation, and scarring, and topical rapamycin being of limited accessibility because of cost and availability.

“Consequently, beta-blockers could prove a useful adjuvant to rapamycin and more traditional directly destructive procedures,” the authors wrote.

Dr. Krakowski and Ms. Nguyen said they had no financial disclosures.

Topical beta-blockers could be an alternative to rapamycin for the treatment of angiofibromas after traditional destructive procedures such as ablative laser resurfacing, according to a case study published in the Aug. 24 edition of Pediatrics.

A 26-year-old woman with tuberous sclerosis complex had her facial angiofibromas treated with ablative fractional laser resurfacing and pulsed-dye laser, with topical timolol 0.5% gel applied to one side of her face twice a day for 2 weeks presurgery and from day 5 after surgery.

At 4 months, there was markedly reduced erythema, and a reduced number and size of angiofibromas on the timolol-treated cheek, compared with the untreated cheek (Pediatrics 2015 Aug 24. [doi: 10.1542/peds.2015-0025]).

“Because angiofibromas are known to contain a highly vascular component expressing angiogenic factors such as VEGF [vascular endothelial growth factor], it is likely the patient’s right cheek improved due to the antiangiogenic and proapoptotic effects of the topically administered beta-blocker,” wrote Dr. Andrew C. Krakowski of the University of California, San Diego, and Tuyet A. Nguyen of the Rady Children’s Hospital, San Diego.

An ideal treatment for angiofibromas remains elusive, with destructive treatments such as cryotherapy, dermabrasion, and radiofrequency or laser ablation associated with complications such as pain, postoperative hyperpigmentation, and scarring, and topical rapamycin being of limited accessibility because of cost and availability.

“Consequently, beta-blockers could prove a useful adjuvant to rapamycin and more traditional directly destructive procedures,” the authors wrote.

Dr. Krakowski and Ms. Nguyen said they had no financial disclosures.

Topical beta-blockers could be an alternative to rapamycin for the treatment of angiofibromas after traditional destructive procedures such as ablative laser resurfacing, according to a case study published in the Aug. 24 edition of Pediatrics.

A 26-year-old woman with tuberous sclerosis complex had her facial angiofibromas treated with ablative fractional laser resurfacing and pulsed-dye laser, with topical timolol 0.5% gel applied to one side of her face twice a day for 2 weeks presurgery and from day 5 after surgery.

At 4 months, there was markedly reduced erythema, and a reduced number and size of angiofibromas on the timolol-treated cheek, compared with the untreated cheek (Pediatrics 2015 Aug 24. [doi: 10.1542/peds.2015-0025]).

“Because angiofibromas are known to contain a highly vascular component expressing angiogenic factors such as VEGF [vascular endothelial growth factor], it is likely the patient’s right cheek improved due to the antiangiogenic and proapoptotic effects of the topically administered beta-blocker,” wrote Dr. Andrew C. Krakowski of the University of California, San Diego, and Tuyet A. Nguyen of the Rady Children’s Hospital, San Diego.

An ideal treatment for angiofibromas remains elusive, with destructive treatments such as cryotherapy, dermabrasion, and radiofrequency or laser ablation associated with complications such as pain, postoperative hyperpigmentation, and scarring, and topical rapamycin being of limited accessibility because of cost and availability.

“Consequently, beta-blockers could prove a useful adjuvant to rapamycin and more traditional directly destructive procedures,” the authors wrote.

Dr. Krakowski and Ms. Nguyen said they had no financial disclosures.