Effectiveness and safety of 0.5% timolol solution in the treatment of pyogenic granuloma: A randomized, double-blind and placebo-controlled study.

Introduction Pyogenic granulomas are benign vascular lesions of the skin and mucosa which are often a source of concern because of their recurrent bleeding even with minimal trauma. Current treatment for pyogenic granuloma is ablative; no medical therapy is standardized to date. Timolol, due to its vasoconstrictive effect, vascular growth factor inhibition and apoptosis promotion properties, is a potential therapeutic option. Objectives: To assess the effectiveness and safety of topical timolol in the treatment of pyogenic granulomas. Methods A two-centre, double-blind and placebo-controlled trial (Registration CTRI/2019/04/018581) was conducted. Patients of either sex were recruited with pyogenic granuloma lesions of less than eight weeks duration. Topical treatment with 0.5% timolol or matching glycerin placebo was continued for six weeks. Changes in color, size, bleeding tendency, physicians' and patients' global assessments and adverse events were assessed. Results Forty subjects were randomized between the two groups which were comparable in age, sex, duration of illness and baseline lesion size.Significant improvement was noted with timolol, with color change from first follow-up onwards and lesion size reduction from second follow-up onward. Patients' assessment of bleeding tendency also showed imrovement from the second visit onward. Between-group comparison showed significant difference with respect to percentage reduction in size (timolol 40.9%, placebo 3.4%; P = 0.002). Rescue treatment (electrosurgery) was required in five patients on placebo and in one in the timolol group (P = 0.182). Complete resolution occurred in 2 (10%) patients with timolol and in no patients on placebo (P = 0.231). Limitations: We observed effects of treatment for only six weeks. Conclusion Topical timolol may be a treatment option for early pyogenic granulomas but complete resolution is unlikely in six weeks. Studies of longer duration are required to assess resolution and recurrence rates.

Granuloma piogénico: presentación de un caso / No disponible

El Granuloma Piogénico es un hiperplasia de la lesión, de forma nodular con el tamaño directamente relacionado con el tiempo de evolución. La superficie puede venir ulcerada y sangrar al mínimo toque o espontáneamente. Su causa puede ser un trauma o infección microbiana. Los autores diagnosticaron un caso de 31 años que asistió a la consulta de dermatología después de un año con una lesión granulomatosa de aproximadamente 4 centímetros de largo y 1,5 centímetros de extensión que refiere después de lo que describe como un forúnculo que fue traumatizado en varias ocasiones por la propia paciente, comienza a notar una tumoración que crece lentamente. Se interconsulta con el Servicio de Cirugía Reconstructiva donde decide exéresis quirúrgico y biopsia, cuyo resultado es Granuloma Piogénico (AU)

The pyogenic granuloma is a hyperplasia on the lesion, in a nodular form and its size is directly related with the time of evolution. The surface can become ulcerated and bleed due to the minimum touch or spontaneously. Its cause can be a trauma or microbial infection. The authors diagnosed a 31 years-old man who attended the consultation of dermatology with a granulomatous lesion of one year evolution and approximately 4 centimeters long and 1,5 centimeters of extension. He refers after what describes as a furuncle that was traumatized in several occasions by the patient himself and began to notice a tumour that grew slowly. The patient was evaluated by the Service of Reconstructive Surgery and we decided a surgical exeresis and to take a biopsy sample show diagnose was Pyogenic Granuloma (AU)