A Controlled Study of Topical 0.25% Timolol Maleate Gel for the Treatment of Cutaneous Infantile Capillary Hemangiomas

Abstract

To evaluate the efficacy of topical 0.25% timolol maleate gel for the treatment of cutaneous infantile capillary hemangiomas. A retrospective, consecutive, nonrandomized, comparative single-masked cohort study of all patients presenting with nonvision-threatening periocular infantile capillary hemangiomas between August 2007 and January 2011 was performed. Parents chose twice daily topical 0.25% timolol maleate gel or observation. Photographs were taken at all visits and subsequently evaluated by masked examiners for change in lesion size, color, and thickness. Lesions were clinically defined as superficial, mixed, or deep. The primary outcome was response to treatment at 2 months, categorized as good (size decreased .50%), moderate (decrease 0-50%), or poor (enlarged or caused visually significant ptosis or induced astigmatism). The secondary outcome was response at latest follow-up visit. Thirteen children received timolol, and 10 children were observed, with mean ages at presentation of 4.8 and 3.7 months (p 5 0.31), respectively. In the treated group, good response was observed in 8 (61.5%) infants, moderate response was seen in 4 (30.8%), and poor response was seen in one patient (7.7%). In the observed group, 0 (0%) demonstrated good response, one (10%) demonstrated moderate response, and 9 demonstrated poor response (90%) (p , 0.001). Responses were consistent on long-term follow-up (range 3-41 months). Both superficial (n 5 5; 100% good response) and mixed (n 5 7; 43% good, 57% moderate) lesions responded well to timolol; the one deep lesion did not. No adverse ocular or systemic effects were observed. Topical timolol maleate gel 0.25% is effective in treatment of nonvision-threatening infantile capillary hemangiomas with a superficial component. Response at 2 months is stable over time.