Topical Timolol Beyond Infancy: A Retrospective Study of Its Use in Persistent Infantile Hemangiomas

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.

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.

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.

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.