Background: Infantile haemangioma (IH) affects 4-10% of infants. Approximately 15% of proliferating IH require intervention during infancy. Oral propranolol is the standard treatment for problematic IH, with associated side effects in up to 31% of cases. Although mostly minor, the potential of hypoglycaemia remains a concern. Few studies on topical timolol for IH exist, many being small case studies with variable treatment durations.
Methods: Infants with superficial IH were enrolled in this prospective interventional qualitative study investigating the effectiveness of topical timolol. One drop of 0.5% timolol gel was applied to the lesion twice daily for 12 months. The patients were followed up at 1, 3, 6 and 12 months or until resolution of the lesion, with serial photographs of the lesions. Patients were monitored for side effects. Side by side before-and-after photographs were evaluated by an independent panel (consisting a plastic surgery trainee, a plastic surgery secretary, a paediatric nurse, a consultant paediatrician, and a mother of a young child without IH) using a visual analogue scale from 0 (no improvement and/or deterioration) to 10 (excellent improvement).
Results: 25 (18 female and 7 male) patients with 28 lH lesions (20 on the face, one on the neck, two on the lower limb and trunk, and three on the upper limb) were enrolled. No adverse effects resulted from topical timolol. 22 (78.6%) and 6 (21.4%) IH lesions had a mean score of ≥5 and <5 improvement following treatment, respectively. Two lesions from one patient were scored 10 uniformly across the panel.
Conclusion: 0.5% topical timolol treatment led to significant improvement of most superficial IH lesions with no side effects.