Timolol

What is an infantile haemangioma?

Infantile haemangioma is the most common blood vessel birth mark in infants. It appears shortly after birth and grows rapidly over a period of a few weeks to months. This phase is followed by a period of very slow reduction in the size of the birth mark and a change in its colour (from bright red to mottled red and skin coloured).

What are the treatment options?

Treatment options depend on the number of haemangiomas and their location and size. Almost all haemangiomas eventually go away without treatment so many cases do not need to be treated.

However, if haemangiomas cause problems there are 2 main treatments. These are a topical treatment called Timolol (applied directly to the haemangioma) and oral called Propranalol (given by mouth). We tend to use Timolol for treating smaller haemangiomas and propranolol for the larger ones.

What is timolol?

Timolol is a medication that belongs to a group of medicines called beta blockers (propranolol is also a beta blocker) which have been used for many years to treat high blood pressure and certain heart problems.

They work in these conditions by affecting blood flow in blood vessels. The effect of beta blockers on haemangiomas was discovered by chance. We still do not fully understand how beta blockers work on haemangiomas but it is likely it is through a similar direct effect on blood vessels.

The Timolol we prescribe to treat haemangiomas is usually used to treat high pressure in the eye. Although the product is labelled as eye drops, because it turns to a gel on contact with the skin, it is suitable for use on haemangiomas.

What are the possible side effects of using timolol?

Topical treatment with timolol is safe but can very rarely cause the following side effects:

• slow heart rate
• low blood pressure
• wheezing and coughing
• cold fingers and toes
• low blood sugar
• feeling tired, sleepy, floppy and becoming quiet
• sleep disturbances (recurrent awakening and occasional nightmares)

If you suspect that your child is experiencing any of the above symptoms, please consult your doctor, pharmacist or contact us on the telephone numbers given at the end of this leaflet.

Does my child need to have any tests?

No tests are needed before starting treatment with timolol.

What is the dose and duration of treatment with timolol?

Timolol will be applied as one drop to the surface of the haemangioma and rubbed on the skin (as it forms a gel) 2 times per day for up to 6 months. This can be extended to a year if there are clear signs of improvement.

Please wash your hands with soap and water before and after putting timolol on your child’s skin.

How often will my child be seen by a dermatologist?

Your child will be reviewed in the dermatology clinics around every 3 months depending on the requirement of each case. It is very important not to stop your treatment unless you discuss this with the dermatology team.