The timing and safety of topical timolol treatment for superficial infantile hemangioma: a retrospective cohort study

Eur J Pediatr. 2025 Jan 24;184(2):151. doi: 10.1007/s00431-025-05983-3.

Abstract

Numerous studies have shown that topical timolol is effective in treating infantile hemangioma (IH) with minimal adverse events. However, consensus is lacking on optimal timing, dosage, frequency, and safety parameters for this treatment. This study aims to explore the timing and safety of topical timolol treatment for superficial IH. A retrospective analysis included pediatric IH patients who underwent topical timolol treatment at the Department of Pediatric Surgery of Sichuan Provincial People's Hospital between January 2019 and January 2023. Medical records were reviewed for patient information, lesion characteristics, outcomes, and complications. Topical timolol was administered to 666 IH patients. Median follow-up was 10 months. 480 cases had excellent or good outcomes, while 186 had fair or poor outcomes. Patients ≤ 3 months had better outcomes than those > 3 months (Z = 4.713, P < 0.001). Small IH had better outcomes than large IH (Z = 1.991, P = 0.046). Lesion locations did not significantly affect outcomes (H = 10.252, P = 0.114). Respiratory problems occurred in 58 (8.7%) cases, localized skin irritation occurred in 48 (7.2%) cases, sleep disturbance occurred in 30 (4.5%) cases, and residual skin lesions occurred in 26 (3.9%) cases. In 59 (8.8%) cases the IH had relapses.

Conclusions: Topical timolol is safe and effective for IH. Patients who are aged 1 < months ≤ 3 or have small (1.5 cm < max diameter ≤ 5 cm) IH are more likely to experience better outcomes. It also may reduce the incidence of residual skin lesions and relapse. Therefore it may be a useful alternative therapy option for superficial IH.

What is known: • β-blockers are now considered to be first-line treatment of infantile hemangioma. • Topical timolol treatment is safe and effective for infantile hemangioma.

What is new: • Patients who are aged ≤ 3 months or have a max diameter ≤ 5 cm infantile hemangioma are likely to experience better outcomes by topical timolol treatment. • Topical timolol treatment may reduce the incidence of residual skin lesions and infantile hemangioma relapses.

Keywords: Adverse effects; Infantile Hemangioma; Retrospective analysis; Timing and safety; Topical timolol.

MeSH terms

  • Administration, Topical
  • Adrenergic beta-Antagonists* / administration & dosage
  • Adrenergic beta-Antagonists* / adverse effects
  • Child, Preschool
  • Drug Administration Schedule
  • Female
  • Hemangioma* / drug therapy
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Retrospective Studies
  • Skin Neoplasms* / drug therapy
  • Timolol* / administration & dosage
  • Timolol* / adverse effects
  • Treatment Outcome

Substances

  • Timolol
  • Adrenergic beta-Antagonists