Topical Timolol for Pyogenic Granuloma: A Systematic Review

Background Pyogenic granuloma (PG) is a benign skin vascular proliferation usually treated with destructive or surgical procedures that may require anaesthesia, particularly in paediatric patients, and may also carry a risk of scarring or recurrence, especially when lesions arise in cosmetically or functionally sensitive sites. Topical timolol has emerged as a low‐morbidity off‐label option, but evidence is heterogeneous. Objective To systematically synthesize efficacy, safety and pragmatic use of topical timolol for PG treatment across age groups and anatomical sites. Methods Following PRISMA 2020, we searched MEDLINE (via PubMed), Scopus and Embase through 30 October 2025 for studies reporting PG treated with topical timolol and extractable outcomes. Data were synthesized narratively; exploratory descriptive comparisons were performed where feasible. Results Twenty‐seven studies (2014–2025) were included, comprising 93 patients with 95 PGs. Mean age was 26.0 ± 21.7 years; paediatric patients (< 18 years) accounted for 40 cases (43.0%). The palpebral conjunctiva was the most frequent site (33, 34.7%). Timolol 0.5% was used in 88 PGs (92.6%), most commonly as an ophthalmic solution applied twice daily; monotherapy was reported in 79 PGs (83.2%). Complete resolution was documented in 56 PGs (58.9%), partial response in 25 (26.3%) and treatment failure requiring procedural escalation in 12 (12.6%). Median time to complete/near‐complete resolution (reported in 52 lesions) was 28 days (IQR 21–39). Recurrence was reported in 3 PGs (3.2%); adverse events were rare (1, 1.1%; mild pruritus). In exploratory analyses, larger PGs and patient older age tended to cluster among partial/nonresponders; complete resolution was reported more often in paediatric than adult cases (72.5% vs. 58.5%). Conclusions Topical timolol is a rational, well‐tolerated conservative option that achieves clinically meaningful regression in a substantial proportion of PGs, particularly in children and in sensitive sites, while acknowledging that nonresponders may require definitive procedures. The evidence base is predominantly case‐based with heterogeneous regimens and limited follow‐up.