Background: Haemangioma of infancy (HOI) on the face may be disfiguring and alarming for parents. Usually they are not treated when they are small. Treatment of HOI with propranolol is a breakthrough. Timolol (topical treatment) and propranolol are closely related. Methods: We considered topical treatment with timolol 0.5% ophthalmic solution 3–4 times daily in patients with small HOI. Twenty patients with small mostly superficial HOI were included. Results: A series of 20 patients with HOI treated with timolol 0.5% ophthalmic solution are described. The treatment was effective in all superficial HOIs after 1–4 months. A quick direct inhibitory effect on the growth of the HOI followed by slower regression was observed. The children had to be treated during the whole proliferative phase. Deep HOIs on the nose (2 cases) and lower eyelid (1 case) showed no response. Conclusion: Topical timolol 0.5% ophthalmic solution is effective in HOI. Safety and effectiveness of drugs like topical timolol and topical propranolol require further investigation but they seem very safe when used in small HOIs. We recommend that small superficial HOIs should be treated in an early proliferative phase.

Keywords:
Haemangioma of infancy, small, Facial disfigurement, Topical treatment, Timolol ophthalmic solution 0.5%, β-Blockers
1.
Drolet BA, Esterly NB, Frieden IJ: Hemangiomas in children. N Engl J Med 1999;341:173–181.
2.
Schwartz RA, Sidor MI, Musumeci ML, Lin RL, Micali G: Infantile haemangiomas: a challenge in paediatric dermatology. J Eur Acad Dermatol Venereol 2010;24:631–638.
3.
Leaute-Labreze C, Dumas de la Roque E, et al: Propranolol for severe hemangiomas of infancy. N Engl J Med 2008;358:2649–2651.
4.
Sans V, de la Roque ED, Berge J, et al: Propranolol for severe infantile hemangiomas: follow-up report. Pediatrics 2009;124:e423–431.
5.
Bayliss SJ, Berk DR, Van Hare GF, Balzer D, Yamada K, Lueder G, Lanoel A, de la Fuente V, Cordisco MR: Re: propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol 2010;27:319–320.
6.
Mishra A, Holmes WJ, Gorst C, Liew SH: Role of propranolol in the management of periocular hemangiomas. Plast Reconstr Surg 2010;126:671.
7.
Lawley LP, Siegfried E, Todd JL: Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol 2009;26:610–614.
8.
Holland KE, Frieden IJ, Frommelt PC, et al: Hypoglycemia in children taking propranolol for the treatment of infantile hemangioma. Arch Dermatol 2010;146:775–778.
9.
Ni N, Wagner RS, Langer P, Guo S: New developments in the management of periocular capillary hemangioma in children. J Pediatr Ophthalmol Strabismus 2011;48:269–276.
10.
Maguiness SM, Frieden IJ: Current management of infantile hemangiomas. Semin Cutan Med Surg 2010;29:106–114.
11.
Pandey A, Gangopadhyay AN, Sharma SP, Kumar V, Gupta DK, Gopal SC: Evaluation of topical steroids in the treatment of superficial hemangioma. Skinmed 2010;8:9–11.
12.
McCuaig CC, Dubois J, Powell J, et al: A phase II open-label study of the efficacy and safety of imiquimod in the treatment of superficial and mixed infantile hemangioma. Pediatr Dermatol 2009;26:203–212.
13.
Guo S, Ni N: Topical treatment for capillary hemangioma of the eyelid using beta-blocker solution. Arch Ophthalmol 2010;128:255–256.
14.
Pope E, Chakkiiakandiyil A:Topical timolol gel or infantile hemangiomas: a pilot study. Arch Dermatol 2010;146:564–565.
15.
Bonifazi E, Mazzotta F, Colonna V, et al: Topical propranolol in the superficial infantile hemangioma of the skin. Eur J Pediatr Dermatol 2010;20:247–251.
16.
Ni N, Wagner PR, Suqin G: Topical timolol for periocular hemangioma: report of further study. Arch Ophthalmol 2011;129:377–379.
17.
Khunger N, Pahwa M: Dramatic response to topical timolol lotion of a large hemifacial infantile haemangioma associated with PHACE syndrome. Br J Dermatol 2011;164:886–888.
18.
Oranje AP, et al: Treatment of small superficial HOI with timolol 0.1% gel or 0.5% ophthalmic solution. Dutch Ned T Derm Venereol 2010;711:711–713.
19.
Janmohamed SR, de Waard-van der Spek FB, Madern GC, de Laat PCJ, Oranje AP: Scoring the proliferative activity of haemangioma of infancy: the Haemangioma Activity Score (HAS). Clin Exp Dermatol 2011;36:715–723.
20.
Janmohamed SR, de Laat PCJ, Madern GC, Oranje AP: Do we have to check glucose in patients with haemangioma of infancy treated with beta-blockers? J Eur Acad Dermatol Venereol 2011, E-pub ahead of print.
21.
Sorrell J, Carmichael C, Chamlin S: Oral sucrose for pain relief in young infants with hemangiomas treated with intralesional steroids. Pediatr Dermatol 2010;27:154–155.
22.
Mishra D, Garg M, Dubey V, et al: Elastic lipsomes mediated transdermal delivery of an anti-hypertensive agent: propranolol hydrochloride. J Pharm Sci 2007;96:145–155.
23.
Jappe U, Uter W, Menezes de Pádua CA, Herbst RA, Schnuch A: Allergic contact dermatitis due to beta-blockers in eye drops: a retrospective analysis of multicentre surveillance data 1993–2004. Acta Derm Venereol 2006;86:509–514.
24.
Valsecchi R, Leighissa P, Piazzolla S, et al: Occupational contact dermatitis from propranolol. Contact Dermatitis 1994;30:177.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.