How Quickly Does Timolol Work for Hemangioma? A Detailed Timeline

October 8, 2025 •

4 min read

Infantile hemangiomas (IH) are the most common pediatric tumor, affecting approximately 5% of newborns [1.8.1, 1.8.6]. This article explores a key treatment question: How quickly does timolol work for hemangioma?

Quick Summary

Topical timolol can show initial improvement in hemangioma color within weeks, with significant size reduction observable over several months. Efficacy depends on lesion type and starting age.

Key Points

Initial Response: A noticeable improvement in the color of the hemangioma can often be seen within the first 4 weeks of treatment with timolol [1.2.3, 1.3.4].
Size Reduction: Significant reduction in the size and volume of the hemangioma typically occurs over 1 to 6 months of consistent application [1.2.1, 1.3.2].
Best Candidates: Timolol is most effective for treating small, thin, and superficial infantile hemangiomas [1.7.1, 1.7.3].
Treatment Duration: A full course of treatment often lasts for a median of 12 months to achieve maximum regression and prevent recurrence [1.2.4].
Safety Profile: Compared to oral propranolol, topical timolol has a much lower risk of systemic side effects, making it a preferred first-line therapy for superficial lesions [1.6.1, 1.6.4].
Early Treatment is Key: Starting timolol treatment at a younger age (e.g., before 3-6 months) is associated with better and faster clinical outcomes [1.6.1, 1.3.7].
Mechanism of Action: Timolol works by constricting blood vessels, inhibiting the growth of new vessels, and promoting cell death within the tumor [1.5.1, 1.5.3, 1.5.4].

Understanding Infantile Hemangiomas and the Role of Timolol

Infantile hemangiomas (IH) are benign vascular tumors that are the most common type of tumor found in infants, affecting up to 10% of children by one year of age [1.8.1, 1.8.3, 1.8.5]. They are characterized by a rapid growth phase in the first few months of life, followed by a slower, spontaneous regression over several years [1.8.3]. While most are harmless, some hemangiomas require treatment due to their location, size, or complications like ulceration [1.8.1, 1.8.6].

For many superficial hemangiomas—those located in the upper layers of the skin—topical beta-blockers have become a first-line treatment option [1.6.4]. Timolol, a non-selective beta-blocker, is frequently prescribed in a gel or solution form (e.g., timolol maleate 0.5%) [1.7.3].

The Mechanism: How Timolol Acts on Hemangiomas

The exact way timolol works to reduce hemangiomas is not fully understood, but its effects are believed to be threefold [1.5.1, 1.5.4]:

Vasoconstriction: Timolol helps to narrow the blood vessels within the hemangioma, which can quickly reduce the bright red color and some of the bulkiness [1.5.1, 1.5.6].
Inhibition of Angiogenesis: The medication is thought to interfere with growth factors like vascular endothelial growth factor (VEGF), which are responsible for the creation of new blood vessels. This action helps to halt the proliferation phase of the hemangioma [1.5.2, 1.5.3].
Induction of Apoptosis: Timolol may promote apoptosis, or programmed cell death, in the excess endothelial cells that make up the tumor, leading to its gradual involution or shrinkage [1.5.1, 1.5.3].

The Treatment Timeline: How Quickly Does Timolol Show Results?

The speed and effectiveness of timolol treatment can vary based on several factors, but studies provide a general timeline for what parents and caregivers can expect.

Initial Changes (First 1-4 Weeks)

The earliest observable change is often in the color of the hemangioma. Many studies report a noticeable fading of the bright red color within the first few weeks of treatment [1.3.2]. One randomized clinical trial noted a significant improvement in lesion color by week 4 of treatment [1.2.3, 1.3.4]. This initial lightening can be reassuring for parents, even if the size has not yet changed dramatically [1.3.4].

Noticeable Regression (1 to 6 Months)

Following the initial color change, a gradual reduction in the size and volume of the hemangioma typically begins. Studies have documented that the lesions become progressively smaller, flatter, and less red over the first several weeks and months [1.3.2].

One study reported response times ranging from 4 to 8 weeks, with size and volume reductions of 55% to 95% observed during follow-ups between 1 to 6 months [1.2.1].
Another case study showed more than 30% reduction after 2 weeks and over 90% by the end of 2 months [1.2.6].

Long-Term Results and Treatment Duration (6 to 12+ Months)

Achieving complete or near-complete resolution often takes several months. The median treatment duration in one large study was 12 months [1.2.4]. Many treatment plans continue until the infant is at least 12 months old to minimize the risk of rebound growth [1.7.1]. In some cases, the hemangioma becomes almost invisible after 9 to 10 months of consistent application [1.3.2].

Factors Influencing Timolol's Efficacy

The response to timolol is not uniform and can be influenced by several key factors:

Type and Depth of Hemangioma: Timolol is most effective for small, thin, superficial hemangiomas [1.7.1, 1.7.2]. It is less effective for deep or mixed-type lesions, where oral medication like propranolol may be required [1.3.7, 1.2.3].
Age at Treatment Initiation: Starting treatment earlier, ideally within the first 1 to 3 months of life during the most rapid growth phase, is associated with better and faster outcomes [1.6.1, 1.7.1].
Location: Lesions on the head and neck have been observed to show more rapid improvement compared to those in other areas [1.3.7].

Comparison: Topical Timolol vs. Oral Propranolol

For superficial infantile hemangiomas, topical timolol is often recommended as a first-line therapy because it has a similar efficacy to oral propranolol but with a significantly lower risk of systemic side effects [1.6.1, 1.6.4].


Feature	Topical Timolol	Oral Propranolol
Best For	Small, thin, superficial IH [1.7.1]	Problematic, deep, large, or rapidly growing IH [1.7.3, 1.7.4]
Administration	Gel or drops applied directly to the skin, typically twice daily [1.2.1, 1.5.5]	Oral liquid given based on the infant's weight [1.7.3]
Efficacy	High for superficial lesions, comparable to propranolol [1.6.1, 1.6.3]	Very high, considered the gold standard for systemic treatment [1.7.3]
Side Effect Profile	Very low risk of systemic effects; rare local irritation [1.4.1, 1.6.1]	Higher risk of systemic effects (sleep disturbance, low heart rate, low blood sugar) requiring monitoring [1.4.4, 1.6.2]

Conclusion

Topical timolol is an effective and safe treatment for many infantile hemangiomas, particularly those that are small and superficial. Parents can expect to see initial color improvement within about four weeks, with a more significant reduction in size and volume over the following months. The total treatment course often lasts around a year to ensure the lesion fully regresses and does not recur. For its intended use, timolol offers an excellent balance of efficacy and safety, making it a cornerstone of modern hemangioma management [1.6.4].

For more information on treatment guidelines, you can visit the American Academy of Pediatrics [1.7.1].

Frequently Asked Questions

You can typically see initial changes, such as the color lightening, within 4 to 8 weeks of starting treatment. More significant reduction in size and volume is often observed over the following 1 to 6 months [1.2.1, 1.3.4].

For small, thin, superficial hemangiomas, topical timolol is often considered a first-line treatment due to its high efficacy and lower risk of side effects. Oral propranolol is typically reserved for larger, deeper, or more complex hemangiomas that require systemic treatment [1.6.1, 1.7.3].

Side effects from topical timolol are rare and usually mild. The most common are local skin reactions like a burning sensation, stinging, or irritation at the application site. Systemic side effects are highly unlikely [1.4.1, 1.4.3].

Typically, one or two drops of timolol solution or a small amount of gel are applied directly to the surface of the hemangioma and gently spread, usually twice a day. Always follow the specific instructions from your doctor [1.2.1, 1.5.5].

No, timolol is most effective for superficial hemangiomas. It is generally not effective for deep or mixed hemangiomas, which may require oral medications like propranolol [1.2.3, 1.3.7].

Studies show that starting treatment at a younger age, such as before 3 to 6 months old, leads to better and faster results. This is because the treatment is most effective during the hemangioma's rapid growth phase [1.6.1, 1.7.1].

The median duration of treatment is often around 12 months. Treatment is typically continued until at least 1 year of age to ensure the hemangioma has fully regressed and to reduce the chance of it growing back [1.2.4, 1.7.1].