Infantile haemangioma: topical timolol

How well does timolol work?

Two small, higher‑quality studies and several larger, lower‑quality studies looked at how well timolol works for treating infantile haemangiomas, when it is applied directly to the surface of the haemangioma as a solution or gel.

In 1 higher‑quality study, haemangiomas near the skin surface were slightly smaller and were less red after applying timolol gel compared with placebo (dummy) gel. In the other higher‑quality study, timolol solution was better than laser treatment for treating haemangiomas near the skin surface, but mixed haemangiomas (with blood vessels near the surface and deep under the skin) improved more with laser treatment.

In a review of mostly lower‑quality studies using timolol to treat mostly surface haemangiomas, about four‑fifths were slightly smaller or less red after timolol treatment.

What are the possible harms or side effects?

Timolol applied directly to the surface of infantile haemangiomas is well tolerated, with few side effects reported. In the studies there was a single case of disturbed sleep in 1 baby and a single case of shortness of breath and difficulty sleeping in another.

However, it is possible that applying timolol to infantile haemangiomas could cause very rare side effects such as slow heart rate, low blood pressure, wheezing and coughing, cold fingers and toes, weakness and fatigue (seen as floppiness and lack of interest in surroundings), disturbed sleep and low blood sugar. See Great Ormond Street Hospital's information on treating small infantile haemangiomas with topical timolol for more details.