What Medication Shrinks Hemangiomas?

October 10, 2025 •

3 min read

Infantile hemangiomas are the most common tumor of infancy, affecting approximately 4% to 5% of infants [1.7.2, 1.7.5]. For those that require intervention, the primary question is: what medication shrinks hemangiomas effectively and safely? Beta-blockers are now the first-line treatment [1.6.5].

Quick Summary

The primary medications that shrink hemangiomas are beta-blockers. Oral propranolol is the FDA-approved, first-line systemic treatment for problematic infantile hemangiomas, while topical timolol is used for smaller, superficial ones [1.2.2, 1.6.3].

Key Points

First-Line Treatment: Beta-blockers are the primary and most effective medications for shrinking hemangiomas [1.6.5].
Oral Propranolol: Oral propranolol (Hemangeol®) is the FDA-approved standard for systemic treatment of large or complicated infantile hemangiomas [1.2.3, 1.2.4].
Topical Timolol: For smaller, superficial hemangiomas, topical timolol gel is a safe and effective option with fewer side effects [1.2.2, 1.2.4].
Corticosteroids: Once the standard of care, corticosteroids are now a second-line treatment due to a higher risk of side effects compared to propranolol [1.5.2, 1.6.3].
Medical Supervision is Essential: Treatment for hemangiomas must be prescribed and monitored by a doctor to manage dosage and potential side effects like hypoglycemia [1.2.1, 1.6.4].
Mechanism: Beta-blockers are thought to work by constricting blood vessels, inhibiting the growth of new vessels, and causing hemangioma cells to die [1.3.1, 1.3.2].
Treatment Timing: Medication is most effective when started during the early, rapid growth phase of the hemangioma [1.3.2, 1.5.2].

Understanding Infantile Hemangiomas and Treatment

Infantile hemangiomas (IH) are benign (non-cancerous) vascular tumors that appear shortly after birth [1.2.1]. While most are harmless and resolve on their own over several years, about 10-15% require treatment due to their location, size, or complications like ulceration or vision obstruction [1.7.1, 1.7.4]. The goal of medication is to stop the hemangioma's growth and accelerate its shrinkage, especially during the rapid proliferation phase in the first few months of life [1.5.2, 1.7.3]. According to the American Academy of Pediatrics (AAP), early referral to a specialist for high-risk hemangiomas is crucial [1.6.2].

The Gold Standard: Oral Beta-Blockers (Propranolol)

Since 2008, beta-blockers have revolutionized the treatment of infantile hemangiomas, replacing corticosteroids as the primary choice [1.2.2, 1.5.2]. Propranolol, taken orally, is the first-line therapy and the only FDA-approved medication for proliferating infantile hemangiomas [1.2.1, 1.2.3, 1.2.4]. The brand name for this formulation is Hemangeol® [1.2.1].

Mechanism of Action The exact way propranolol works is not fully understood, but it's believed to have three main effects [1.3.1, 1.3.3]:

Vasoconstriction: It narrows the existing blood vessels within the hemangioma, reducing blood flow and causing a rapid change in color and softness [1.3.2, 1.5.2].
Inhibition of Angiogenesis: It blocks the signaling pathways and growth factors (like VEGF) that lead to the creation of new blood vessels [1.3.1, 1.5.2].
Induction of Apoptosis: It triggers programmed cell death in the endothelial cells that make up the tumor [1.3.1, 1.3.2].

Administration and Monitoring Propranolol is a liquid solution given by mouth, typically twice a day with or immediately after a feeding to reduce the risk of hypoglycemia (low blood sugar) [1.2.1, 1.6.4]. The dose is carefully calculated based on the infant's weight and may be gradually increased by the doctor [1.2.1]. Close monitoring by a physician experienced in its use is essential, and may involve checking heart rate and blood pressure [1.2.6, 1.5.2]. Treatment usually lasts for at least six months [1.2.2].

Topical Treatments: Beta-Blocker Gels (Timolol)

For smaller, thinner, and more superficial hemangiomas that don't require systemic medication, topical beta-blockers are a common choice [1.2.2, 1.2.4]. Timolol maleate, available as a gel or ophthalmic solution, is applied directly to the surface of the skin [1.2.4].

This treatment is considered safe and effective for uncomplicated, superficial IH, especially those not on mucosal surfaces or already ulcerated [1.4.2]. Timolol works similarly to propranolol but on a local level, with less risk of systemic side effects because of lower absorption into the bloodstream [1.4.5]. It is particularly effective when started early in the infant's life (under 3 months) for smaller lesions [1.4.4, 1.4.7].

Other and Historical Medical Treatments

Before beta-blockers became the standard, other medications were more common.

Corticosteroids Systemic corticosteroids (like prednisolone) were the first-line treatment for decades [1.5.2]. They work by inhibiting vascular growth factors but are now considered a second-line therapy due to a higher rate of side effects compared to propranolol [1.5.2, 1.6.3, 1.6.5]. These can include irritability, growth retardation, hypertension, and cushingoid facies [1.5.2]. Intralesional (injected) steroids may still be used for specific cases, such as small, bulky, or deep lesions [1.2.2, 1.5.6, 1.6.3].

Vincristine For very severe, life-threatening, or treatment-resistant hemangiomas, a chemotherapy agent called vincristine may be used [1.2.5, 1.8.3]. It is typically reserved for cases that fail to respond to steroids or other therapies [1.8.1, 1.8.2, 1.8.4]. It is administered intravenously and requires specialist care [1.8.1].

Comparison of Common Hemangioma Medications


Medication	Type/Administration	Best For	Common Side Effects
Propranolol	Oral liquid (Systemic)	Problematic, large, deep, or complicated IH requiring systemic treatment [1.2.4, 1.6.3].	Sleep problems, low blood sugar (hypoglycemia), slowed heart rate, cold extremities, diarrhea [1.2.1, 1.3.2].
Timolol	Topical gel/solution	Small, thin, superficial, and uncomplicated IH [1.2.4, 1.4.2, 1.6.3].	Localized skin irritation is possible, but systemic side effects are minimal [1.4.4, 1.4.5].
Corticosteroids	Oral (Systemic) or Injected (Intralesional)	Second-line therapy for cases with contraindications to propranolol; injected form for some focal, bulky lesions [1.6.3, 1.6.5].	Irritability, cushingoid features, growth delay, hypertension, immunosuppression [1.5.2].

Conclusion

The management of infantile hemangiomas has significantly advanced, with beta-blockers emerging as the clear front-line treatment. The answer to what medication shrinks hemangiomas is now overwhelmingly propranolol for systemic cases and timolol for superficial ones. These medications offer high efficacy with a more favorable side effect profile than older treatments like corticosteroids [1.5.2, 1.6.5]. Nonetheless, because all medications carry risks, any treatment for an infantile hemangioma must be managed by a qualified healthcare professional who can weigh the benefits against potential risks for each individual child [1.2.4].

For further reading, the American Academy of Dermatology (AAD) provides reliable information for patients and families.

Frequently Asked Questions

The main medication is oral propranolol, a beta-blocker that is FDA-approved for treating proliferating infantile hemangiomas. For smaller, superficial lesions, topical timolol is often used [1.2.2, 1.2.4].

The effects of propranolol can be rapid, with some changes in the hemangioma's color and softness seen within 24 to 48 hours of starting treatment. Studies show that 88% of patients on Hemangeol (propranolol) showed improvement after 5 weeks [1.2.3, 1.3.2].

When used properly under medical supervision, propranolol is considered safe and effective. It requires careful dosing based on weight and monitoring for side effects like low blood sugar, slow heart rate, and sleep disturbances. Doses should be given with food [1.2.1, 1.6.4].

No, topical treatments like timolol gel are typically only effective for small, thin, superficial hemangiomas. Deeper, larger, or more complicated hemangiomas usually require systemic medication like oral propranolol [1.2.2, 1.2.4].

Before propranolol became the first-line treatment around 2008, systemic corticosteroids (like prednisolone) were the mainstay of therapy for complicated hemangiomas [1.2.2, 1.5.2].

The common side effects of propranolol, like sleep disturbances or cold extremities, are generally reversible and dose-dependent [1.5.2]. Side effects from long-term steroid use, such as growth delay, also tend to be transient and resolve after treatment stops [1.5.2].

If there is a contraindication or an inadequate response to propranolol, a doctor might consider oral corticosteroids as a second-line therapy. In very rare and severe cases that are resistant to other treatments, medications like vincristine may be used [1.6.3, 1.8.2].