Efficacious Healing of Ulcerated Infantile Hemangiomas Using Topical Timolol

Abstract

Infantile hemangiomas (IHs) are the most common benign pediatric soft-tissue tumors. Ulceration-the most frequent complication of IH-tends to heal poorly and is associated with pain, bleeding, infection, and scarring. Mainstay treatment modalities include propranolol (β-blocker) and corticosteroids, whose effectiveness is countered by a need for long-term medication and risk of systemic adverse effects and ulcer recurrence. A 3-month-old infant presented to us with a large, medial thigh-ulcerated IH that progressed despite 2 prior months of dressings and topical antimicrobials. Topical timolol 0.5% thrice daily was initiated, and significant healing was evident at 1 week, with complete healing at 1 month. Timolol was stopped after 3 months, and at 18 months after cessation of timolol, there was no ulcer recurrence. This novel therapy for ulcerated IH seems to have many advantages such as rapid efficacy with easy application, no systemic adverse effects and no long-term recurrence, and current literature describing similar advantages justifies the use of this treatment modality in infants.

Fig. 1.

A, Left thigh hemangioma (50 mm × 50 mm) with superior-half ulceration (35 mm × 35 mm) in a 5-month-old child, progressing despite 2 months of topical antimicrobial initiation and before timolol initiation. B, Ulceration clearly starting to heal and contract after just 1 week of application of 2 drops of 0.5% topical timolol thrice daily. C, Complete healing after 1 month of timolol, leaving behind a whitish telangiectasic scar.