Topical timolol

What is an infantile haemangioma and what does it look like?

An infantile haemangioma is a benign (non-cancerous) overgrowth of the small blood vessels and are usually within the skin. They were previously referred to as “strawberry marks” because of their appearance. Haemangiomas can lie close to the skin surface (superficial), deep to the skin surface (deep), or can be a combination of both (mixed). Haemangiomas can be of varying shades of red, purple or blue, depending upon how deep or superficial it is. For example, superficial haemangiomas can appear as a raised, bright red area of skin, whilst deeper haemangiomas may appear bluish in colour.

Infantile haemangiomas can develop prior to birth or shortly after. A small red mark or a swelling may be noticed at birth or during the first few weeks of life. Infantile haemangiomas can grow quickly in the first 3 to 4 months, increasing in size and redness. Thereafter, they usually grow much more slowly for up to twelve months. An infantile haemangioma then enters a phase of regression, and gradually reduces in size. This process can take several years.

What causes infantile haemangioma’s?

The cause of infantile haemangiomas is unknown. They are noted to be more common in Caucasian children, females, premature infants with low birthweight, twin/multiple births and with increasing maternal age.

Does my child need treatment?

Most infantile haemangiomas often do not require any treatment at all. Small haemangiomas may respond to topical timolol if treatment is required. A large haemangioma is unlikely to respond to topical treatment.

What is topical timolol and how is it used?

Timolol maleate 0.5% is a beta blocker medication in a gel form designed for use in the eye. It is usually used for a condition called glaucoma. To treat an infantile haemangioma the gel is spread on to the affected area of skin once or twice daily. Approximately 1-2 drops should be sufficient depending on the size of the area and should be spread over the entire surface. It is best to make sure the area is clean and dry before applying. The treatment process can take several months and your child will be monitored accordingly by the Paediatric Dermatology team.

How does topical timolol work for an infantile haemangioma?

Topical timolol is a beta-blocker medication in gel form. It has been shown to be safe and effective when used on small infantile haemangiomas. It works by blocking receptors on the blood vessels of your child’s haemangioma, making them narrower and reducing the amount of blood flowing through them.

This treatment can help stop haemangiomas from growing and may help speed up the process of shrinking. Topical timolol can also reduce the colour and make the haemangioma softer.

What are the possible side effects of topical timolol?

It is highly unlikely that your child will experience any side effects. However, the most common local side effects of the area being treated include a feeling of burning, stinging and irritation.

Less common side effects include dizziness, low blood sugar, sleep disturbance or wheeze/cough. If any of these side effects occur, please seek urgent medical advice.

Useful sources of information

• British Association of Dermatologists (BAD)
• DermNet NZ
• British Association of Dermatologists (BAD) – patient information leaflets

For further information

Medicines information patient helpline

Our medicines information helpline is for Newcastle Hospitals patients to answer questions they may have regarding their medicines.

Out-of-hours advice

Contact NHS 111 or visit your nearest urgent treatment centre.