Treatment of Superficial Strawberry Birthmarks with Topical Timolol

This is an open labelled phase II study assessing the effectiveness of 0.5% topical timolol gel in the treatment of superficial infantile haemangiomas (IHs) . Most IHs do not require active treatment as they involute spontaneously over time. However, up to 10-15% of IH require intervention during infancy because they cause complications, such as visual and airway obstruction, ulceration, bleeding, and permanent disfigurement. Following spontaneous involution, approximately 50% of the lesions will leave a blemish, and half of these will require treatment. Currently propanolol is the mainstay treatment of problematic IHs. We have demonstrated that oral propranolol at 1.5–2 mg/kg/day is an effective and safe treatment for problematic proliferating IH. However, many of the untreated IH can cause permanent cosmectic blemish, affecting the skin and/or leaving subcutaneous fatty residuum following spontaneous involution. Earlier treatment (during the early proliferative phase) has been shown to result in better outcomes and reduced short and long-term complications. Parents/caregivers will be shown how to apply this gel to the IH. 1 drop morning and night applied topically to the IH. Treatment will be increased to 1 drop three times a day, morning,noon and night, after 2 months if there is no improvement and there are no adverse effects. Treatment is continued until complete resolution of the lesion occurs, there is no change in lesion size, colour or consistency after 3 months of continued use, until the patient reaches 12 months of age, or if any criteria for removal from the study are met.