A Novel Classification of Infantile Hemangioma Growth Patterns and Its Clinical Implications for Topical Timolol Therapy

Background: Infantile hemangiomas (IHs) show diverse growth patterns that influence response to topical beta-blockers. We propose a functional classification—exophytic, endophytic, peripheral, and combined—to guide the choice of topical timolol delivery. Methods: Retrospective review of 347 IHs categorized by growth pattern. All lesions received 1% timolol maleate gel. Peripheral IHs were treated by simple spreading 3–5× daily; exophytic, endophytic, and combined IHs received occlusive compresses for 2–3 h, BID–TID at 6–8 h intervals. Many patients were monitored via telemedicine; segmental or >5 cm IHs were excluded. Results: In peripherally growing IHs, topical application halted growth in 99% and achieved complete regression in 98% within 6–10 months. With occlusion, complete resolution occurred in 89% of exophytic (9–12 months), 73% of endophytic (8–14 months), and 81% of combined IHs (10–14 months); simple topical use was ineffective in these groups. No systemic side effects were observed, apart from occasional patch irritation. Conclusion: The proposed growth-pattern classification helps match the application method to the lesion, improving treatment efficacy and consistency. Occlusion enhances transdermal delivery, supporting practical outpatient and teledermatology management.