Topical Timolol for Small Hemangiomas of Infancy

:  Propranolol has become the treatment of choice of large and complicated infantile hemangiomas. There is a controversy concerning the safety of systemic propranolol. Here we show that topical use of the beta‐blocker timolol can also inhibit the growth and promote regression of infantile hemangioma...

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Bibliographic Details
Published in:Pediatric dermatology 2013-03, Vol.30 (2), p.245-249
Main Authors: Moehrle, Matthias, Léauté‐Labrèze, Christine, Schmidt, Verena, Röcken, Martin, Poets, Christian‐F., Goelz, Rangmar
Format: Article
Language:English
Subjects:
Administration, Topical
Adrenergic beta-Antagonists - administration & dosage
Adrenergic beta-Antagonists - therapeutic use
Female
Hemangioma - drug therapy
Humans
Infant
Infant, Newborn
Male
Skin Neoplasms - drug therapy
Timolol - administration & dosage
Timolol - therapeutic use
Treatment Outcome
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Summary::  Propranolol has become the treatment of choice of large and complicated infantile hemangiomas. There is a controversy concerning the safety of systemic propranolol. Here we show that topical use of the beta‐blocker timolol can also inhibit the growth and promote regression of infantile hemangiomas. In this case series we treated 11 infantile hemangiomas in nine children including six preterm babies with the nonselective betablocker timolol. A timolol containing gel was manufactured from an ophthalmic formulation of timolol 0.5% eyedrops. This gel was applied using a standardized occlusive dressing (Finn‐Chambers) containing approximately 0.25 mg of timolol. In all infants topical timolol was associated with growth arrest, a reduction in redness and thickness within the first 2 weeks. Seven hemangiomas showed almost complete resolution, and four became much paler and thinner. No data are available on the transdermal absorption of timolol. Even supposing complete absorption of timolol from the occlusive dressing, a maximum dose of 0.25 mg of timolol would result per day and hemangioma. Regression of infantile hemangiomas treated using 0.5% timolol gel in this case series occurred earlier than spontaneous regression which is generally not observed before the age of 9–12 months. The promising results need to be verified in prospective randomized trials on topical beta blocker administration for infantile hemangiomas which should address dose, duration, and mode of application.
ISSN:0736-8046
1525-1470
DOI:10.1111/j.1525-1470.2012.01723.x