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Is topical timolol monotherapy safe and effective in the management of high-risk infantile haemangioma?
  1. Manal Patel
  1. School of Clinical Medicine, University of Cambridge, Cambridge, UK
  1. Correspondence to Ms Manal Patel, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP, UK; mp778{at}

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Clinical bottom line

  • Topical timolol (0.5%) showed similar efficacy to oral propranolol in the treatment of superficial infantile haemangioma (grade C).

  • Topical timolol had a significantly lower risk of eliciting adverse systemic side effects, which may be preferential in treating premature infants and as such precluding the need for aggressive clinical monitoring (grade C).


A 9-week-old premature neonate in the neonatal intensive care unit has developed a superficial infantile haemangioma (IH) involving the inner half of her left upper eyelid. You are concerned due to the tendency for rapid proliferation in this high-risk periocular location as well as the possibility of facial disfigurement. A colleague advises that pharmacological treatment, with either systemic or topical beta-blockade, is usually the treatment of choice. You wonder whether topical timolol monotherapy is as effective as oral propranolol in eliciting involution.

Clinical question

In infants with high-risk IH (patient), is topical timolol monotherapy (intervention) compared with oral propranolol (comparison) safe and effective in eliciting regression …

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  • Contributors MP has sole accountability for all aspects of the work including conception, data acquisition and interpretation and has given final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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