British Journal of Dermatology | 2019
Bullous pemphigoid and cancer in Taiwan
Abstract
well as adverse events associated with treatment. They conclude that analysis of eligible trials suggests that oral propranolol (3 mg kg 1 day ) improves clinician-assessed clearance compared with placebo, that topical timolol maleate gel (0 5% twice daily) probably increases the chance of reducing haemangioma redness vs. placebo, and that neither intervention appears to be associated with an increase in serious adverse effects compared with placebo. Furthermore, analysis from one study found no difference in size reduction of superficial haemangiomas from either oral propranolol (1 mg kg 1 once daily) or topical timolol maleate (0 5% eye drops twice daily), with no clear difference in adverse events. Although the full Cochrane review identified 28 eligible trials including 1728 participants and covering 12 different interventions, trials relevant to their abridged paper specifically looking at propranolol and timolol numbered just five, incorporating information on a total of 379 children (range 14–258). In addition, the quality of evidence was ranked as very low to medium and the risk of bias was considered high. Variability in reported outcomes from these studies was significant, e.g. clinician-ranked clearance, or reductions in volume or degree of redness of the haemangioma, rendering meta-analysis impossible. Moreover, data on a number of important outcomes, particularly patient/carer-related assessments, were lacking. While there is such variability in clinical practice over betablocker choice and treatment, the predominant message of this abridged review is perhaps not so much about the value and safety of propranolol and timolol in infantile haemangiomas, but rather, it emphasizes a pressing need for further highquality randomized controlled trials of beta blockers and other therapies in large cohorts of infants. Standardization of objective outcome measures, inclusion of patient-related outcomes and careful capture of adverse events will be key to gaining the utmost value from future studies.