Efficiency of Topical Beta-Blockers for Epistaxis Control in Ulcerated Infantile Hemangioma

Infantile hemangiomas (IHs) are common childhood benign tumors that are generally self-limiting in nature. However, they can lead to complications, including pain, ulceration, or permanent disfigurement. Successful treatment methods include oral and topical beta-blockers. We report a case of a two-month-old girl, born full-term, who presented with daily epistaxis that began approximately one week after birth. The epistaxis was previously treated with nasal saline drops. Endoscopy revealed an ulcerating hemangioma over the right anterior nasal septum with involvement of the maxillary crest. The remainder of her physical examination was unremarkable, with no concerns for further airway pathologies. We initiated a trial of topical Timolol 0.5% TID for one month while continuing nasal hygiene with saline spray and Vaseline. Epistaxis ceased after only a few days of Timolol use, and substantial improvement in appearance, bleeding, and nasal crusting of the right anterior septum was noted. However, the hemangioma was found to be extending into the anterior soft tissue, including the oral vestibulum. Imaging was obtained, and systemic treatment with propranolol was added to her regimen. The mainstay and first-line treatment for IHs currently consists of topical beta-blockers (such as Timolol) and oral propranolol. In this case, the topical application of Timolol effectively controlled the bleeding and restore function but had limited impact on overall tumor regression, necessitating additional systemic therapy. Although systemic treatment may not always be readily available or may be limited due to potential side effects, early use of topical beta-blockers can be considered a relatively simple and safe first-line treatment option for controlling the symptoms of an intranasal IH in the early life of an infant.