Treatment of Infantile Hemangiomas With Beta-Blockers

A Review

Sonal Shah, MD; Ilona J. Frieden, MD


Skin Therapy Letter. 2013;18(6) 

In This Article

Topical β-blockers

For superficial or small IH, in which systemic therapy may not be indicated, topical β-blockers, specifically timolol gel forming solution (GFS), have proven to be a useful alternative. In a recent multicenter retrospective study looking at the efficacy of timolol 0.5%-0.1% GFS applied twice daily for superficial IH, 72 of 73 patients exhibited some improvement, the mean duration of therapy was 3.4 months and treatment was well tolerated.[38] However, some caution must be exercised with the use of topical timolol due to its increased potency of between 4 and 10 times greater than propranolol, as well, topical absorption would bypass first-pass metabolism in the liver. To date, a small amount of topical timolol (e.g., 1 drop applied twice a day to intact skin overlying a hemangioma) appears to be safe, but the exact level of systemic absorption is not yet known. Thus, a conservative and cautious approach should be practiced in administering topical timolol while awaiting further information about potential side effects.[39]