Intralesional steroids, topical steroids, beta-blockers, and laser
Topical timolol is a beta-blocker which is licensed as an eye drop for the treatment of glaucoma. It has been shown to be effective in treating hemangiomas that are relatively localized, small and less elevated, either because they have not yet thickened or because they have never grown to be thick. Potential known side effects include skin irritation; until more is known, it is probably best avoided in ulcerated or larger hemangiomas as the effects of systemic absorption are not yet well understood.
A small amount of steroids may be injected directly into hemangiomas, especially those that are localized and more elevated. Injections are often utilized for one to several treatments, at 3 to 4 week intervals. This form of therapy is typically used for small hemangiomas (1-3 cm) on the face or lips. The potential side effects include skin atrophy (thinning) or systemic absorption.
Clobetasol, a very strong steroid ointment, applied 2x/day can be used to treat relatively flat hemangiomas, particularly if they are not becoming thick during the growth phase. The main potential side effects are skin atrophy (thinning) or systemic absorption.
Topical imiquimod 5%
Topical imiquimod has been published for superficial hemangioma treatment, however there is frequently a significant amount of inflammation and crusting that may make treatment difficult. The potential for absorption and immune effects are not known.
Right Cheek: This girl with a very superficial hemangioma in her right cheek (segment 2) was treated with topical steroids and pulsed dye laser with minimal residual hemangioma at age 4 years. (Pictures courtesy of Dr. Ilona Frieden)
Forehead: This girl’s superficial hemangioma was treated with topical steroids and pulsed dye laser with minimal residual hemangioma at age 4 years. (Pictures courtesy of Dr. Ilona Frieden)