Imiquimod 5% cream versus timolol 0.5% ophthalmic solution for treating superficial proliferating infantile haemangiomas: a retrospective study

Clin Exp Dermatol. 2013 Dec;38(8):845-50. doi: 10.1111/ced.12150. Epub 2013 Apr 30.


Background: Infantile haemangiomas (IHs) are the most common vascular tumours of infancy. Topical therapies are a possible treatment for superficial IHs.

Aim: To determine the efficacy and safety of topical therapy in the treatment of superficial proliferating IHs.

Methods: The medical records of all the patients with proliferating superficial IHs were reviewed. All lesions had been treated either with imiquimod 5% cream or timolol 0.5% ophthalmic solution. Lesions were classified into pairs, with one of each treatment in each pair, matched by anatomical location, colour and size. A visual analogue scale (VAS) and the Haemangioma Activity Score (HAS) were used to evaluate the efficacy of the two drugs. The paired Student t-test was used to test for differences in recovery with these two treatments.

Results: In total, 51 patients treated with timolol and 94 treated with imiquimod met the inclusion criteria, and 20 lesions treated with timolol were successfully matched to a lesion treated with imiquimod. The paired t-test indicated that there was no significant difference in either VAS score (P = 0.11) or HAS (P = 0.49). For the imiquimod-treated patients, crusting was the most common reaction (65.0%, 13/20). This did not cause any superficial scarring or skin pigmentation in the matched pairs; however, superficial scars (14.9%, 14/94) and skin pigmentation disorders (28.7%, 27/94) were reported for some of the unmatched cases. There were no adverse events (AEs) during the treatment with timolol.

Conclusions: Both imiquimod 5% cream or timolol 0.5% ophthalmic solution showed equivalent clinical efficacy after 4 months of treatment. Timolol appeared to have fewer AEs than imiquimod in the management of superficial IHs. Larger, prospective controlled trials with long-term treatment are needed to confirm these results.

MeSH terms

  • Administration, Topical
  • Adrenergic beta-Antagonists / administration & dosage*
  • Aminoquinolines / administration & dosage*
  • Antineoplastic Agents / administration & dosage*
  • Female
  • Hemangioma / drug therapy*
  • Hemangioma / pathology
  • Humans
  • Imiquimod
  • Infant
  • Male
  • Retrospective Studies
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / pathology
  • Timolol / administration & dosage*


  • Adrenergic beta-Antagonists
  • Aminoquinolines
  • Antineoplastic Agents
  • Timolol
  • Imiquimod