Topical Timolol Effective for Infantile Hemangioma

Khunger N and Pahwa M. Dramatic response to topical timolol lotion of a large hemifacial infantile haemangioma associated with PHACE syndrome. Br J Dermatol 2011 Apr; 164:886.

Since 2008, propranolol has been used increasingly for the off-label treatment of infantile hemangiomas. Timolol is a topical beta-blocker commonly used for glaucoma that showed therapeutic promise for hemangiomas in a few case reports and small pilot studies.

Case report from India describe the treatment of an 18-month-old girl with PHACE syndrome and an extensive, disfiguring hemifacial hemangioma complicated by ulceration, palpebral occlusion, and ipsilateral cerebellar hypoplasia.

After systemic corticosteroids failed to produce response, topical timolol ophthalmic solution 0.5% was applied to the hemangioma (10 drops, twice daily). The hemangioma shrank dramatically within a week, and timolol was discontinued at 12 weeks.

Pulse, blood pressure, and serum glucose were monitored closely and remained stable throughout treatment. Local irritation was the only reported adverse effect.

Comments:
Randomized, controlled studies of the safety and efficacy of topical beta-blockers for hemangiomas are under way.

In this case report, systemic absorption of timolol may have been a key factor in the dramatic success. Until we know more, systemic therapy should probably remain first-line therapy for time-sensitive problematic hemangiomas (e.g., those that threaten vision).