Topical timolol maleate treatment of infantile hemangiomas

Katherine Püttgen, Anne Lucky, Denise Adams, Elena Pope, Catherine McCuaig, Julie Powell, Dana Feigenbaum, Yulia Savva, Eulalia Baselga, Kristen Holland, Beth Drolet, Dawn Siegel, Kimberly D. Morel, Maria C. Garzon, Erin Mathes, Christine Lauren, Amy Nopper, Kimberly Horii, Brandon Newell, Wei SongIlona Frieden

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


BACKGROUND: There has been a dramatic increase in the off-label use of ophthalmic timolol maleate, a β-blocker used for infantile hemangioma (IH) treatment as a topical counterpart to oral propranolol. Its safety and efficacy in a pediatric population with IH have not been evaluated in a large cohort. Our goal was to retrospectively assess timolol's effectiveness, discern characteristics associated with response, and document reported adverse events. METHODS: A multicenter retrospective cohort study of 731 patients treated with topical timolol was completed at 9 centers. Inclusion required an IH suitable for timolol in the treating physician's judgment and access to clinical details including photographs. Logistic regression analysis and descriptive statistics were performed. Primary outcome measures were efficacy assessed by using visual analog scales for color and for size, extent, and volume from review of digital photographs taken as standard of care. RESULTS: Most IHs were localized (80.1%) and superficial (55.3%). Risk of disfigurement was the most common indication for therapy (74.3%). Duration of therapy (P < .0001), initial thinness (P = .008), and subtype (P = .031) were significant predictors of response. Best response occurred in superficial IHs <1 mm thick. Fifty-three (7.3%) required subsequent therapy with systemic β-blocker. Adverse events were mild, occurring in 25 (3.4%) patients. No cardiovascular side effects were documented. CONCLUSIONS: Timolol seems to be a well-tolerated, safe treatment option with moderate to good effectiveness, demonstrating best response in thin, superficial IHs regardless of pretreatment size. Timolol can be recommended as an alternative to systemic β-blockers and watchful waiting for many patients.

Original languageEnglish (US)
Article numbere20160355
Issue number3
StatePublished - Sep 2016

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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