Key Action Statement 3G: Clinicians may prescribe topical timolol maleate as a therapy for thin and/or superficial IHs (grade B, moderate recommendation).

Aggregate Evidence QualityGrade B
BenefitModest benefit in IH clearance
HarmLow but possible risk of local irritation, sleep disturbance, cold extremities, bronchospasm, and bradycardia, with more caution needed in preterm infants and those without intact skin (ie, ulceration)
CostCost of medication
Benefits-harm assessmentBenefits outweigh harms
Value judgmentsNone
Role of patient preferenceParents have a significant role in decision-making regarding the desire to treat small superficial lesions for which timolol may be effective
Intentional vaguenessNone
ExclusionsLesions that are large size, significantly elevated, or life-threatening
StrengthModerate recommendation
Key references40,46,85,122126