Peer-reviewed article
Topical Timolol Beyond Infancy: A Retrospective Study of Its Use in Persistent Infantile Hemangiomas.
Bogomolets O, Bogomolets-Sheremetieva S ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a medical study about treating infantile hemangiomas (benign blood vessel tumors) in children aged 1-5 years using topical timolol, a beta-blocker medication. The study found that topical timolol was effective in 98% of children treated before age 1, but only 69% of those treated between ages 1-5. Higher concentration timolol (1%) worked better than lower concentration (0.5%) in older children. The research was conducted in Ukraine and notes that telemedicine supervision was practical during the period of military conflict.
Key points
- Topical timolol 0.5% had limited effectiveness in children aged 1-5 years with persistent hemangiomas
- Increasing to topical timolol 1% resulted in clinical improvement in older children
- 98% positive response rate in children treated before age 1, compared to 69% in those treated between ages 1-5
- Treatment could be safely administered at home under remote medical supervision
- In six patients, topical timolol remained effective even after systemic beta-blocker therapy had failed
Limitations
This is a retrospective study from a single specialized vascular center in Ukraine, so findings may not generalize to other settings or populations. The study acknowledges that natural involution of hemangiomas over time may partially explain positive outcomes, making it difficult to isolate the true effect of the medication.
Abstract
Introduction Infantile hemangiomas (IH) usually undergo spontaneous involution; however, some lesions remain visible after infancy and may cause psychosocial distress in children and their families. Evidence regarding the effectiveness of topical beta-blockers when treatment is initiated after infancy remains limited. Methods This real-world study evaluated the efficacy of topical timolol therapy in children aged 1-5 years with persistent IH. Children with IH were evaluated at a specialized vascular anomalies center in Ukraine between 2019 and 2024. Parents of children older than 1 year with persistent visible IH associated with psychosocial distress were offered vascular laser therapy or topical timolol treatment. Because topical therapy could be administered safely at home under remote medical supervision during ongoing military action, all families chose this option. A short initial treatment period of 2-4 weeks was used to assess the therapeutic response, and treatment was continued if improvement was observed. Results A total of 2419 children with IH were evaluated during the study period. Among them, 1287 patients used topical timolol as monotherapy. Treatment was initiated after the age of 1 year in 113 patients with persistent lesions. Positive outcomes were observed in 1151 (98.04%) patients who started therapy before the age of 1 year and in 78 (69.03%) patients who initiated treatment between 1 and 5 years of age (p < 0.001). Topical timolol 0.5% demonstrated limited effectiveness in older children, whereas switching to topical timolol 1% resulted in clinical improvement. In six patients previously treated with systemic beta-blockers, topical timolol remained effective even after systemic therapy had lost effectiveness. Natural involution of IHs may be partially responsible for the positive effect observed in some of our patients. Conclusions These findings suggest that topical timolol 1% may provide clinically meaningful improvement in persistent IH beyond infancy and support telemedicine-based treatment when access to in-person care is limited.