Topical Beta-Blocker Effective First-Line Treatment for Infantile Hemangioma

by Linda Kossoff •

CLINICAL QUESTION

How efficient are topical beta-blockers for epistaxis control in a case of ulcerated infantile hemangioma (IH)?

BOTTOM LINE

The topical beta-blocker timolol can be an effective first-line treatment for controlling symptoms of ulcerated IHs; however, its use should be carefully monitored.

BACKGROUND: Infantile hemangiomas are benign, vascular tumors occurring in approximately 4 to 5% of infants. Self-limiting in nature, IHs can still lead to complications such as pain, ulceration, or permanent disfigurement if left untreated. The mainstay and first-line treatment for IHs consists of topical beta-blockers and oral propranolol.

STUDY DESIGN: Case study

SETTING: Otolaryngology–Head and Neck Surgery, University of Florida Health, Gainesville, Fla.

SYNOPSIS: An eight-week-old, full-term, otherwise healthy patient presented with recurrent epistaxis from the right nostril and no concerns for impaired breathing, stridor, or possible compromised airway. Examination revealed an ulcerating hemangioma over the right anterior nasal septum. Continued management with saline spray and Vaseline and a one-month trial of topical timolol 0.5% was recommended. At two weeks, epistaxis had ceased. At four weeks, the hemangioma had improved in appearance but was extending into the oral vestibulum/upper lip and upper jaw. The patient was referred to pediatric cardiology for management of systemic beta-blocker propranolol. Magnetic resonance imaging was ordered to assess the extent of the mass and rule out intracranial abnormalities. At eight weeks, these measures had been taken, but the family subsequently relocated, precluding further follow-up. Researchers note that this case supports the efficacy of topical timolol for controlling symptoms such as bleeding in ulcerated IHs and underscores the importance of close monitoring and the potential need for systemic therapy in cases with limited response to topical treatment. In this case, persistent tumor growth required further intervention, suggesting that more frequent monitoring during the first month of treatment could be helpful.

CITATION: Lam N, Schrepfer T. Efficiency of topical beta-blockers for epistaxis control in ulcerated infantile hemangioma. Cureus. 2024;16(8):e67709. doi: 10.7759/cureus.67709.