Patient Support Information

Treating small infantile haemangiomas with topical timolol
What is a haemangioma?
How are haemangiomas usually treated?
What is timolol maleate and how does it help with haemangiomas?
Are there any side effects with topical timolol treatment?
Are there any tests needed before starting timolol treatment?
What dose should my child have and how do I administer it?
Queries/concerns?
Further information

Treating small infantile haemangiomas with topical timolol

This information leaflet explains how small infantile haemangiomas are treated with topical timolol, a medicine historically used to treat high eye pressure (glaucoma). Not all haemangiomas are suitable for this treatment.

There are no topical timolol preparations licensed for treating infantile haemangiomas, so the use of any topical timolol preparation for this condition is “off label”.

What is a haemangioma?

A haemangioma, sometimes referred to as a ‘strawberry birthmark’, is a collection of small blood vessels, which appears red if it’s on the surface of the skin or bluish if deeper. Usually haemangiomas are not present at birth and become apparent within the first few days to weeks. They typically grow rapidly for several months and then shrink slowly over subsequent years.

How are haemangiomas usually treated?

The vast majority of haemangiomas resolve on their own and do not require any active treatment. However, for those that interfere with function (around the eyes, lips, nose or nappy region) beta-blocker medications are the first choice of treatment. They can be given orally (by mouth) or applied topically (as a gel to the surface of the haemangioma). Topical application is generally only used for small haemangiomas.

What is timolol maleate and how does it help with haemangiomas?

Timolol works by making blood vessels narrower, reducing the amount of blood flowing through them. This is useful when treating haemangiomas, as restricting the blood flow helps to reduce the growth, size and redness of the haemangioma faster than would occur without treatment.

Timolol is typically continued until your child is around 12 months old. After stopping treatment, the haemangioma will continue to shrink over the following years. By early school years, depending on the site of the haemangioma there may be little sign it ever existed.

In the minority of cases where topical treatment fails to stop the haemangioma from growing, then an oral beta-blocker medication (called propranolol) may be prescribed in selected cases. Unlike propranolol, timolol doesn’t usually require special monitoring.

Are there any side effects with topical timolol treatment?

Timolol comes in a variety of forms, but the one used at the Royal Belfast Hospital for Sick Children is a gel-forming solution called Timoptol®-LA 0.5%. Topical administration of timolol is safe and side effects are extremely rare, apart from occasional numbness or tingling of the skin at the time of application.

However, you should report any of the following to your doctor as the dose of timolol may need to be altered or stopped. Potential side effects will be explained to you at the first consultation:

• Slow heart rate (bradycardia)
• Low blood pressure (hypotension)
• Low blood sugar (hypoglycaemia)
• Wheeze (bronchospasm)
• Cold hands and feet (peripheral vasoconstriction)
• Low body temperature (hypothermia)
• Sleep disturbance/nightmares.

Are there any tests needed before starting timolol treatment?

If your child has several haemangiomas on the skin, we may carry out an abdominal ultrasound scan to look for haemangiomas deeper in the body. Also, before starting treatment and at several points during treatment your child will have clinical photographs taken to monitor progress.

Please let us know if your child was born prematurely or had a low-birthweight (less than 2.5kg) as this may affect the dose of timolol prescribed.

What dose should my child have and how do I administer it?

The average dose is 1-3 drops twice a day as directed. Apply the drop directly to the haemangioma and carefully spread it with your finger to cover the surface of the haemangioma. Wash your hands before and after putting timolol on your child’s skin.

Queries/concerns?

If you have any queries or concerns please contact our department using the details below, or alternatively discuss with your GP:

Paediatric dermatology secretary
Secretarial office
Basement
Royal Belfast Hospital for Sick Children
Grosvenor Road
Belfast, BT12 6BA
Tel: 028 9063 4482

Further information

British Association of Dermatologists (bad.org.uk)

Birthmark Support Group Tel: 0845 045 4700

Changing Faces | Visible Difference & Disfigurement Charity Tel: 0845 450 0275