An infantile hemangioma is a common type of birthmark that appears as a growth of extra blood vessels, often on or under a baby’s skin. These benign growths, sometimes called “strawberry marks,” are not present at birth but emerge within the first few weeks to months of life. While many infantile hemangiomas naturally shrink and disappear over time without intervention, some may require treatment due to their size, location, or potential for complications. For these cases, topical timolol has become a widely used medication to manage the growth and appearance of the hemangioma.
Mechanism of Action
Timolol is a nonselective beta-blocker medication, which means it affects certain receptors in the body. Although its exact mechanism for treating hemangiomas is still being explored, it is understood to act through several pathways. Timolol reduces blood flow within the hemangioma by causing vasoconstriction (narrowing of blood vessels).
Timolol also influences the cells that contribute to hemangioma growth. It inhibits angiogenesis, the formation of new blood vessels, slowing the proliferation of excess cells. The medication also promotes apoptosis, programmed cell death, encouraging excess cells within the hemangioma to die off. These combined actions contribute to the shrinking and fading of the hemangioma.
Application and Treatment Protocol
Topical timolol for infantile hemangiomas comes in a gel or solution form, often a 0.5% concentration. To apply the medication, a very thin layer is spread directly onto the hemangioma. Use one to three drops, or enough to cover the entire surface of the lesion.
Application is twice daily, after cleaning the affected area. Wash hands thoroughly before and after applying the gel or solution. Treatment often continues for several months, or until the lesion has significantly improved or resolved. Following the prescribing doctor’s specific instructions regarding dosage, frequency, and overall treatment length is important for optimal results.
Safety and Potential Side Effects
Since timolol is applied directly to the skin, the risk of systemic side effects is considerably lower compared to oral medications. However, some local side effects at the application site can occur. These might include mild skin irritation, redness, or dryness. These reactions are usually temporary and well-tolerated.
While rare, more serious systemic side effects can occur due to some absorption of the medication through the skin. Parents should monitor for signs such as lethargy, bradycardia (slow heart rate), hypotension (low blood pressure), or changes in breathing like wheezing or coughing. Although these systemic effects are uncommon, vigilance is advised, especially for very young or premature infants, or if the medication is applied to large or ulcerated areas. Any concerns should be promptly discussed with a healthcare provider.
Treatment Candidacy and Expectations
Topical timolol is a suitable treatment for specific types of infantile hemangiomas. These include small, thin, and superficial hemangiomas, often appearing as bright red patches or bumps on the skin surface. It is effective for lesions less than 5 cm in diameter and in infants aged three months or younger.
Hemangiomas that are large, deep, ulcerated, or located in high-risk areas such as near the eyes or airway might require different treatment approaches, such as oral propranolol. When using topical timolol, initial lightening of the hemangioma’s color may be observed within weeks, with continued improvement in size and appearance over several months. The goal of treatment is significant fading and prevention of further growth or complications, rather than complete disappearance.