Efficacy of topical timolol versus saline in chronic venous ulcers-a randomized controlled trial

INTRODUCTION: Chronic venous stasis ulcers, sometimes fail to heal inspite of adequate treatment. Non healing is possibly due to chronic activation of -Receptor (B2-AR) in the keratinocytes by endogenously generated catecholamines which inhibits keratinocyte migration. Blocking of B2-AR using beta blockers have been reported to promote wound healing, by promoting keratinocyte migration, angiogenesis; increased dermal fibroblast migration and epidermal differentiation. Thus topical timolol a B2-AR antagonist, has been used to promote wound healing. The purpose of this study is to demonstrate if topical timolol enhances wound healing in venous leg ulcer OBJECTIVE: To compare the efficacy of topical timolol versus saline in chronic venous leg ulcers and to compare the mean reduction in ulcer area at the end of 4weeks. MATERIALS AND METHODS: 20 patients with chronic venous leg ulcer were randomized into two groups. Patients in Group 1 were treated with 1 drop of 0.5% topical timolol instilled every 2 cm2 of wound edge, then covered with sterile dressing every alternate days for 4 weeks. Ulcer margins were measured and ulcer area calculated every week for 4 weeks. Similar dressing and measurement was done for patients in Group 2 with saline for 4 weeks. Healing rate was assessed by the percentage of reduction of ulcer area of both groups at week 4 compared to week 0. RESULTS: The mean reduction in the area of the ulcer size in timolol group was 85.51%, and the mean reduction in the area of the ulcer size in saline group was 42.74% which was statistically significant with a P < 0.001 and t = 4.11. CONCLUSION: Topical timolol is an easy, effective, non invasive and inexpensive therapy that can be recommended for chronic ulcer.