{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:39:11Z","timestamp":1792064351827,"version":"4.4.0"},"reference-count":26,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,9,1]]},"abstract":"<jats:p>Angiofibromas are the most recognized cutaneous manifestations of tuberous sclerosis complex. Angiofibromas can be associated with disfigurement, bleeding, pruritus, and erythema and may lead to significant psychosocial consequences for affected patients. Histopathologically, angiofibromas consist of a mixture of vascular and interstitial cells. Traditional treatment options include cryotherapy, electrocoagulation, radiofrequency ablation, dermabrasion, laser treatment, and topical agents such as podophyllotoxin. However, complications such as pain, postinflammatory hyperpigmentation, scarring, and the frequent recurrence rate reduce the utility of these treatment options. The introduction of topical rapamycin marked a turning point for treatment of facial angiofibromas; however, the lack of a standardized formulation, limited insurance coverage, and significant financial cost restrict universal access for patients and their caregivers. Both oral and topical \u03b2-blockers have proven extremely effective treatments for superficial vascular tumors such as hemangiomas and pyogenic granulomas. Topical \u03b2-blockers may potentially be useful for treatment of angiofibromas considering these lesions also contain a vascular component. Here we present an exploratory case report of a patient with tuberous sclerosis complex who had significant clinical improvement of her facial angiofibromas utilizing a \u201csplit-face\u201d comparison protocol of topical timolol 0.5% gel after full-field treatment with ablative fractional laser resurfacing and pulsed-dye laser.<\/jats:p>","DOI":"10.1542\/peds.2015-0025","type":"journal-article","created":{"date-parts":[[2015,8,25]],"date-time":"2015-08-25T00:09:53Z","timestamp":1440461393000},"page":"e709-e713","source":"Crossref","is-referenced-by-count":16,"title":["Inhibition of Angiofibromas in a Tuberous Sclerosis Patient Using Topical Timolol 0.5% Gel"],"prefix":"10.1542","volume":"136","author":[{"given":"Andrew C.","family":"Krakowski","sequence":"first","affiliation":[{"name":"University of California, San Diego, La Jolla, California; and"},{"name":"Rady Children\u2019s Hospital, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuyet A.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of California, San Diego, La Jolla, California; and"},{"name":"Rady Children\u2019s Hospital, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2015,9,1]]},"reference":[{"key":"2021121021083158900_B1","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/B978-0-444-52891-9.00038-5","article-title":"Tuberous sclerosis.","volume":"111","author":"Curatolo","year":"2013","journal-title":"Handb Clin Neurol"},{"issue":"1","key":"2021121021083158900_B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2133.1996.tb03597.x","article-title":"The cutaneous features of tuberous sclerosis: a population study.","volume":"135","author":"Webb","year":"1996","journal-title":"Br J Dermatol"},{"issue":"11","key":"2021121021083158900_B3","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1136\/adc.2011.211995","article-title":"The Tuberous Sclerosis 2000 Study: presentation, initial assessments and implications for diagnosis and management.","volume":"96","author":"Yates","year":"2011","journal-title":"Arch Dis Child"},{"issue":"2","key":"2021121021083158900_B4","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/j.1365-2133.2008.08677.x","article-title":"The mTOR inhibitor rapamycin significantly improves facial angiofibroma lesions in a patient with tuberous sclerosis.","volume":"159","author":"Hofbauer","year":"2008","journal-title":"Br J Dermatol"},{"issue":"6","key":"2021121021083158900_B5","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.ad.2012.11.020","article-title":"Current options for the treatment of facial angiofibromas.","volume":"105","author":"Salido-Vallejo","year":"2014","journal-title":"Actas Dermosifiliogr"},{"issue":"5","key":"2021121021083158900_B6","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1067\/mjd.2001.116223","article-title":"Treatment of angiofibromas with a scanning carbon dioxide laser: a clinicopathologic study with long-term follow-up.","volume":"45","author":"Bittencourt","year":"2001","journal-title":"J Am Acad Dermatol"},{"issue":"1","key":"2021121021083158900_B7","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/bjd.13388","article-title":"The use of propranolol in the treatment of infantile hemangiomas: an update on potential mechanisms of action.","volume":"172","author":"Ji","year":"2015","journal-title":"Br J Dermatol"},{"issue":"2","key":"2021121021083158900_B8","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/j.1365-2133.2010.09848.x","article-title":"Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action.","volume":"163","author":"Storch","year":"2010","journal-title":"Br J Dermatol"},{"issue":"7","key":"2021121021083158900_B9","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.bjoms.2012.12.003","article-title":"Propranolol given orally for proliferating infantile haemangiomas: analysis of efficacy and serological changes in vascular endothelial growth factor and endothelial nitric oxide synthase in 35 patients.","volume":"51","author":"Yuan","year":"2013","journal-title":"Br J Oral Maxillofac Surg"},{"issue":"2","key":"2021121021083158900_B10","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1056\/NEJMoa063564","article-title":"Sirolimus for angiomyolipoma in tuberous sclerosis complex or lymphangioleiomyomatosis.","volume":"358","author":"Bissler","year":"2008","journal-title":"N Engl J Med"},{"issue":"5","key":"2021121021083158900_B11","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/j.jpeds.2013.12.053","article-title":"Mammalian target of rapamycin inhibitors for intractable epilepsy and subependymal giant cell astrocytomas in tuberous sclerosis complex.","volume":"164","author":"Cardamone","year":"2014","journal-title":"J Pediatr"},{"issue":"5","key":"2021121021083158900_B12","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1016\/j.juro.2014.04.096","article-title":"Efficacy and safety of sirolimus for renal angiomyolipoma in patients with tuberous sclerosis complex or sporadic lymphangioleiomyomatosis: a systematic review.","volume":"192","author":"Peng","year":"2014","journal-title":"J Urol"},{"issue":"7","key":"2021121021083158900_B13","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1001\/archdermatol.2010.125","article-title":"Topical rapamycin: a novel approach to facial angiofibromas in tuberous sclerosis.","volume":"146","author":"Haemel","year":"2010","journal-title":"Arch Dermatol"},{"issue":"1","key":"2021121021083158900_B14","doi-asserted-by":"crossref","first-page":"15","DOI":"10.5070\/D36TB7N61M","article-title":"Facial angiofibromas treated with topical rapamycin: an excellent choice with fast response.","volume":"18","author":"Truchuelo","year":"2012","journal-title":"Dermatol Online J"},{"issue":"6","key":"2021121021083158900_B15","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1111\/bjd.12567","article-title":"First left-right comparative study of topical rapamycin vs. vehicle for facial angiofibromas in patients with tuberous sclerosis complex.","volume":"169","author":"Tanaka","year":"2013","journal-title":"Br J Dermatol"},{"issue":"1","key":"2021121021083158900_B16","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/j.1440-0960.2011.00837.x","article-title":"Topical 0.1% rapamycin for angiofibromas in paediatric patients with tuberous sclerosis: a pilot study of four patients.","volume":"53","author":"Foster","year":"2012","journal-title":"Australas J Dermatol"},{"issue":"1","key":"2021121021083158900_B17","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1159\/000357033","article-title":"Treatment of angiofibromas in tuberous sclerosis complex: the effect of topical rapamycin and concomitant laser therapy.","volume":"228","author":"Park","year":"2014","journal-title":"Dermatology"},{"issue":"9","key":"2021121021083158900_B18","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1001\/archdermatol.2011.254","article-title":"Dramatic improvement of facial angiofibromas in tuberous sclerosis with topical rapamycin: optimizing a treatment protocol.","volume":"147","author":"DeKlotz","year":"2011","journal-title":"Arch Dermatol"},{"issue":"24","key":"2021121021083158900_B19","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1056\/NEJMc0708819","article-title":"Propranolol for severe hemangiomas of infancy.","volume":"358","author":"Leaute-Labreze","year":"2008","journal-title":"N Engl J Med"},{"issue":"6","key":"2021121021083158900_B20","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1111\/bjd.13116","article-title":"A pyogenic granuloma treated with topical timolol.","volume":"171","author":"Malik","year":"2014","journal-title":"Br J Dermatol"},{"issue":"1","key":"2021121021083158900_B21","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/pde.12297","article-title":"Pyogenic granuloma in a 5-month-old treated with topical timolol.","volume":"32","author":"Khorsand","year":"2015","journal-title":"Pediatr Dermatol"},{"issue":"3","key":"2021121021083158900_B22","doi-asserted-by":"crossref","first-page":"20","DOI":"10.5070\/D3203021726","article-title":"Resolution of recalcitrant pyogenic granuloma with laser, corticosteroid, and timolol therapy.","volume":"20","author":"Millsop","year":"2014","journal-title":"Dermatol Online J"},{"issue":"2","key":"2021121021083158900_B23","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/pde.12217","article-title":"Treatment of pediatric pyogenic granulomas using \u03b2-adrenergic receptor antagonists.","volume":"31","author":"Wine Lee","year":"2014","journal-title":"Pediatr Dermatol"},{"issue":"7","key":"2021121021083158900_B24","first-page":"37","article-title":"Beta blockers: an innovation in the treatment of infantile hemangiomas.","volume":"7","author":"Admani","year":"2014","journal-title":"J Clin Aesthet Dermatol"},{"issue":"1","key":"2021121021083158900_B25","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/j.1525-1470.2011.01664.x","article-title":"Timolol maleate 0.5% or 0.1% gel-forming solution for infantile hemangiomas: a retrospective, multicenter, cohort study.","volume":"29","author":"Chakkittakandiyil","year":"2012","journal-title":"Pediatr Dermatol"},{"issue":"2","key":"2021121021083158900_B26","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/IOP.0b013e31823bfffb","article-title":"A controlled study of topical 0.25% timolol maleate gel for the treatment of cutaneous infantile capillary hemangiomas.","volume":"28","author":"Chambers","year":"2012","journal-title":"Ophthal Plast Reconstr Surg"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/136\/3\/e709\/912712\/peds_2015-0025.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/136\/3\/e709\/912712\/peds_2015-0025.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T06:47:45Z","timestamp":1639205265000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/136\/3\/e709\/61202\/Inhibition-of-Angiofibromas-in-a-Tuberous"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,9,1]]},"references-count":26,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2015,9,1]]},"published-print":{"date-parts":[[2015,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2015-0025","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,9,1]]}}}