Efficacy and safety of combined oral propranolol, oral prednisolone, and topical timolol versus combination of oral propranolol plus topical timolol in treating infantile hemangioma.

Objective: To determine the efficacy and safety of combined oral propranolol, oral prednisolone, and topical timolol in treating infantile hemangioma. Study Design: Randomized Clinical Trial. Setting: Department of Dermatology, Allied II (DHQ) Hospital Faisalabad Medical University, Faisalabad. Period: October 23 to August 24. Methods: A total of 68 infants aged 1 month to 5 years with clinically diagnosed infantile hemangiomas (IHs) were enrolled through non-probability consecutive sampling. Infants with comorbidities such as asthma, cardiac disease, or prior treatment were excluded. Participants were randomized into two groups: Group D (dual therapy) received dual therapy (oral propranolol and topical timolol only) while Group T (Triple) received triple therapy (oral propranolol, oral prednisolone, and topical timolol). Patients were followed biweekly for the first month and monthly thereafter for three months. Treatment efficacy was assessed based on lesion regression, while secondary outcomes included side effects and parental satisfaction. Results: Improvement (25–100% reduction) was observed in 88% of patients in Group D and 97% of patients in Group T, But not statistically significant. However, the incidence of mild-to-moderate side effects was notably higher in Group D (32%) compared to Group T (6%), which was statistically significant. Conclusion: Both the combinations of oral propranolol, oral prednisolone, and topical timolol and the combination of oral propranolol and topical timolol demonstrated high efficacy, but triple therapy had better results with less complications.