Infantile hemangiomas (IHs) are a common pediatric lesion. Orally administered β-blockers
have been reported as effective in treating these lesions. However, oral administration is also associated with systemic adverse effects. Treatment with locally administered β-blockers
may provide acceptable efficacy with lower incidence of adverse effects. This may offer a better first-line treatment.
PubMed was searched through March 2014 for studies reporting patient-level response of 5 or more patients treated with intralesional propranolol
timolol, or topical propranolol
for cutaneous IHs. Rates of response to treatment, defined as clinically significant regression, were combined using random-effects meta-analysis
Ninety-four articles were identified. Seventeen articles met the study criteria. These studies primarily focused on superficial IHs. Response rates for topical propranolol
timolol were not significantly different, 76% [95% confidence interval (CI), 62%–86%] and 83% (95% CI, 65%–93%), respectively (P
= 0.45). Prospectively conducted studies reported lower response rates compared to retrospective studies for both topical propranolol
= 0.06) and topical
< 0.01). When only prospectively conducted studies were included, response rates for topical propranolol
timolol were not significantly different, 72% (95% CI, 57%–83%) and 72% (95% CI, 53%–86%), respectively (P
= 0.98). Significant adverse effects were rare. Only 1 case of sleep disturbance was reported across 554 patients from all studies.
Topically administered β-blockers
are an effective treatment for superficial IHs that pose few adverse effects and should be considered for primary treatment.