Utility of topical timolol in the management of chronic non-healing foot ulcers
DOI:
https://doi.org/10.18203/2349-2902.isj20230973Keywords:
Chronic wounds, Non-healing, Foot ulcers, Diabetic foot, Topical timololAbstract
Background: Chronic foot ulcers often do not respond to conventional therapy and result in amputations. Treatment is protracted, expensive and affects the quality of life of the patient. The objective of the study is the efficacy of topical timolol in the treatment of chronic non-healing foot ulcers and the feasibility of its use in a rural/semi-urban population.
Methods: An observational, cross-sectional study was conducted at a tertiary hospital situated on the outskirts of Bengaluru from January 2021 to July 2022. Sample size was 95. Topical timolol maleate solution was applied on day 1, 3 and 7 and followed up on days 15 and 30. During each visit the wound was assessed and the area of ulcer was measured. Repeated measures ANOVA was applied to compare the area of ulcer on day 1, 15 and 30 and mean percentage of reduction calculated at different time intervals using post-hoc Bonferroni.
Results: Demographic data: predominantly male (61.1%), mean age 48.74±14.8 years, from lower socioeconomic background. 45.3% were diabetics. Efficacy of timolol: mean ulcer area on day 1, 15 and 30 was 70.95, 51.8 and 39.95 cm2 respectively (p=0.001). There was a significant reduction in mean percentage of ulcer area on day 15 and day 30 (p=0.001). No adverse effects due to timolol were observed.
Conclusions: Topical timolol is safe, inexpensive and effective. Its use in the treatment of chronic non-healing foot ulcers would be beneficial to a country like India which has a large rural population.
Metrics
References
Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle). 2015;4(9):560-82.
Martinengo L, Olsson M, Bajpai R, Soljak M, Upton Z, Schmidtchen A, et al. Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies. Ann Epidemiol. 2019;29:8-15.
Shubhangi Vinayak Agale. Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management. Ulcers, 2013;413604:9.
Slawiński P, Radkowski M, Lewandowicz A, Targowski T. Mixed-etiology leg ulcers in a patient on long-term glucocorticoid therapy. Reumatologia. 2019;57(3):173-7.
Kumar G, Dash P, Patnaik J, Pany G. Socioeconomic status scale- Modified Kuppuswamy Scale for the year 2022. Int J Comm Dent. 2022;10(1):1-6.
Oliver TI, Mutluoglu M. Diabetic Foot Ulcer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
Robertson D, Biaggioni I. Adrenoceptor Antagonist Drugs. In: Katzung BG, Trevor AJ. Basic & Clinical Pharmacology. 13th ed. McGraw-Hill; 2015.
Sivamani RK, Lam ST, Isseroff RR. Beta adrenergic receptors in keratinocytes. Dermatol Clin 2007;25:643-53.
Pullar CE, Chen J, Isseroff RR. PP2A activation by beta2-adrenergic receptor agonists: novel regulatory mechanism of keratinocyte migration. J Biol Chem 2003;278:22555-62.
Rai AK, Janani K, Rai R. Efficacy of Topical Timolol versus Saline in Chronic Venous Ulcers: A Randomized Controlled Trial. J CutanAesthet Surg. 2020;13(1):18-23.
Kaur R, Tchanque-Fossuo C, West K. Beta-adrenergic antagonist for the healing of chronic diabetic foot ulcers: study protocol for a prospective, randomized, double-blinded, controlled and parallel-group study. Trials. 2020;21(1):496.
Braun LR, Lamel SA, Richmond NA, Kirsner RS. Topical timolol for recalcitrant wounds. JAMA Dermatol 2013;149:1400-2.
Vestita M, Filoni A, Bonamonte D, Annoscia P, Giudice G. Topical 0.5% Timolol for Chronic Refractory Wounds. An Observational Prospective Study. Plast Reconstr Surg Glob Open. 2017;5(9 Suppl):21.
Alsaad AMS, Alsaad SM, Fathaddin A, Al-Khenaizan S. Topical timolol for vasculitis ulcer : A potential healing approach. JAAD Case Rep. 2019;5(9):812–4.
Manahan MN, Peters P, Scuderi S, Surjana D, Beardmore GL. Topical timolol for a chronic ulcer–a case with its own control. Med J Aust 2014;200:49-50.
Tang JC, Dosal J, Kirsner RS. Topical Timolol for a refractory wound. Dermatologic Surgery. 2012;38(1):135-8.
Lev-Tov H, Dahle S, Moss J, Isseroff RR. Successful treatment of a chronic venous leg ulcer using a topical beta-blocker. J Am Acad Dermatol. 2013;69:e204-5.
Thomas B, Kurien JS, Jose T, Ulahannan SE, Varghese SA. Topical timolol promotes healing of chronic leg ulcer. J Vasc Surg Venous Lymphat Disord 2017;5:844-50.
