Some infantile hemangiomas can be managed with topical therapy

Superficial, relatively thin infantile hemangiomas (IHs) responded to several months of treatment with topical timolol maleate in a recent trial, suggesting that this treatment is an alternative to oral propranolol for selected IHs.

The multicenter retrospective study was conducted in 731 infants with IHs treated with topical timolol at 9 centers. Most IHs were localized (80.1%) and superficial (55.3%). Almost half of patients were aged younger than 3 months when treatment was initiated, and participants had received timolol maleate for a mean of about 9.5 months when the study began. For most patients, the dose was 1 drop of the agent applied twice daily to the IH surface.

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Significant predictors of response were longer duration of therapy, initial thinness (best response was in IHs <1 mm thick), and superficial IH subtype (rather than a mixed or deep IH). Topical timolol was more effective in improving the color of the IH than in reducing its size, whatever the infant’s age or how long he or she was treated. Adverse events, which were triggered in only 3.4% of participants, were mild (Püttgen K, et al. Pediatrics. 2016;138[3]:e20160355).

Commentary

It has been fascinating to watch as beta blockers, old standby medications, have quickly become the treatment of choice for IHs. Remember though, that most IHs require no therapy and will regress on their own before the infant reaches school age. For those lesions that do need treatment because of their location, size, or associated complications, beta blockers may be the best way to go and now, for some IHs, topical beta blockers. -Michael G Burke, MD 

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.