Comparative Efficacy of 1% Timolol in Treating Infantile Hemangiomas with Deep Growth Tendencies: Topical Application vs. Occlusive Compresses

Background: Infantile hemangiomas (IHs) with deep endophytic growth often respond poorly to conventional topical timolol therapy. Enhancing transdermal delivery may improve outcomes. Methods: Among 347 IH cases, 112 lesions ≤5 cm with notable subcutaneous extension were analyzed. Initial therapy was direct topical application of 1% timolol solution, 2–3 times daily for 2–4 weeks. Non-responders were switched to occlusive compresses: cotton pads soaked in timolol, applied 2–3 h every 8 h and sealed under occlusion. Follow-up included Doppler ultrasonography or photographic monitoring. All patients were treated between 2 and 6 months of age, mainly via telemedicine during wartime restrictions in Ukraine. Results: Direct topical application produced only limited improvement. After switching to occlusion, 73% of patients achieved 90–100% regression within 9–12 months. The occlusive technique was well tolerated, with no systemic side effects; only minor local irritation was observed in a few cases. Conclusion: Occlusive compresses with 1% timolol are a more effective and safe option for IHs with deep endophytic growth than standard topical use. This approach enhances drug penetration and is especially valuable when systemic beta-blockers are contraindicated or declined, enabling safe home-based telemedicine treatment.