Ulcerated infantile hemangioma: novel treatment with topical brimonidine-timolol

We report a 2-month-old boy with a painful ulcerated hemangioma on the lower mucosal lip extending to the vermillion border that caused feeding difficulty. It was successfully treated with topical brimonidine 0.2% and timolol 0.5%, a combination selective α2 -adrenergic agonist and nonselective β-blocker. After 6 weeks of treatment, the lesion reepithelialized and the patient's symptoms and functional complications resolved. Brimonidine 0.2% timolol 0.5% ophthalmic solution is an emerging alternative treatment for hemangiomas, offering the potential to target hemangioma growth through two synergistic mechanisms (β-inhibition and α2 -agonism) that may be especially effective for ulcerated lesions, the most common complication of infantile hemangiomas.