Timolol for Treatment of Recalcitrant Pyogenic Granulomas: a Case Report and Review of the Literature

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Paige Hoyer
Priscilla Ly
Lindy Ross
Michael Wilkerson


timolol, pyogenic, granuloma


Importance: Pyogenic Granuloma (PG) is a benign vascular tumor that forms commonly on the face, oral mucosa, or a site of previous injury. Though some PGs resolve spontaneously, most require some-to-multiple form(s) of treatment to prevent bleeding, ulceration, and scarring. Current treatment options for PGs include cryotherapy, laser, electrodessication, curettage or shave excision, sclerotherapy, corticosteroid injections, and imiquimod 5% cream. Timolol 0.5% ophthalmic solution has been used as a noninvasive topical treatment for PG in the pediatric population.

Objective: To present a case of successful treatment of a recalcitrant PG with topical timolol, and to report on the current literature for similar cases.

Case Presentation: We present a case of a 40-year-old healthy female who developed a biopsy-proven PG on her index finger. This is the first reported case to successfully use tangential biopsy and electrodessication followed by twice daily topical Timolol to treat recalcitrant PG.

Conclusions: This case supports the use of 0.5% Timolol ophthalmic solution and demonstrates that it is a safe and economical therapy for adult patients with recurrent PGs. A review of the current literature is discussed, and supports timolol as an easy and economical therapy option.


1. Walsh J, Eady J. Vascular tumors, Hand Clinics, 20(3):261-268. 2004 Aug.

2. Millsop JW, Trinh N, Winterfield L., Berrios R., Hutchens KA., Tung R. Resolution of Recalcitrant Pyogenic Granuloma with laser, corticosteroid, and timolol therapy. Dermatology Online Journal. 20(3), 2014 Mar.

3. Gilmore A, Kelsberg G, Safranek S. Clinical inquiries. What's the best treatment for pyogenic granuloma? J Fam Pract, 59:40-2. 2010 Jan.

4. Leaute-Labreze C, Dumas de la Roque E, Hubiche T., et al. Propranolol for severe hemangiomas of infancy. N Engl J Med 358(24):2649–2651 2008 Jun.

5. Shah S, Frieden IJ. Treatment of Infantile Hemangiomas with Beta-Blockers: a Review. Skin Therapy Letter, 18(6):5-7. 2013 Sept-Oct.

6. Wine Lee L, Goff KL, Lam JM, Low DW, Yan AC, Castelo-Soccio L. Treatment of pediatric pyogenic granulomas using B-adrenergic receptor antagonists. Pediatr Dermatol, 31(2):203-7. 2013 Oct.

7. Qiu Y, Ma G, Yang J, et al. Imiquimod 5% cream versus timolol 0.5% ophthalmic solution for treating superficial proliferating infantile haemangiomas: a retrospective study. Clin Exp Dermatol 38(8):845–850. 2013 Apr.

8. Chakkittakandiyil A, Phillips R, Frieden IJ, Siegfried E, Lara-Corrales I, Lam J, et al. Timolol maleate 0.5% or 0.1% gel-forming solution for infantile hemangiomas: a retrospective, multicenter, cohort study. Pediatr Dermatol 29:28-31. 2011 Dec.

9. Chiriac A, Birsan C, Podoleanu C, Moldovan C, Brzezinski P, Stolnicu S. Noninvasive Treatment of Pyogenic Granulomas in Young Children with Topical Timolol and Trichloroacetic Acid, The Journal of Pediatrics, 169:322. 2016 Feb.

10. Gupta D, Singh N, and Thappa DM. Is timolol an effective treatment for pyogenic granuloma? Int J Dermatol, 55(5):592-5. 2016 Feb.

11. Khorsand K, Maier M, and Brandling-Bennett HA. Pyogenic Granuloma in a 5-Month-Old Treated with Topical Timolol. Pediatr Dermatol, 32(1):150-1. 2014 Mar.

12. Knöpfel M, Escudero-Góngora M, Bauzà A, Martín-Santiago A. Timolol for the treatment of pyogenic granuloma (PG) in children, Journal of the American Academy of Dermatology, 75(3):105-106. 2016 Sept.

13. Malik M, Murphy R. A Pyogenic Granuloma Treated with Topical Timolol. British Journal of Dermatology 171(6):1537-8. 2014 Dec.

14. Resenstein R, Lewellis S, Leger M. Periungual pyogenic granuloma formation in a patient with complex regional pain syndrome. Dermatology online journal. 21(12) 2015 Dec.

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