Dramatic response to topical timolol lotion of a large hemifacial infantile haemangioma associated with PHACE syndrome

Funding sources: none. Conflicts of interest: none declared. Madam, The PHACE syndrome is an uncommon condition seen in a subgroup of children, particularly associated with large segmental facial haemangiomas. It is an acronym coined by Frieden et al.1 for the association of Posterior fossa defects, Haemangiomas, Arterial anomalies, Cardiac defects and Coarctation of the aorta, and Eye anomalies. The ‘S’ in PHACES syndrome signifies associated Sternal clefting and/or Supraumbilical raphe. The haemangiomas associated with PHACE syndrome are typically large, prone to ulceration, and generally require treatment. Traditional treatment options for haemangiomas include observation, systemic and intralesional corticosteroids, interferon alfa‐2a, vascular lasers, sclerotherapy, embolization, immunomodulators and surgery.2 3–4 The first use of a beta blocker, oral propranolol, for infantile haemangiomas was reported in 2008.5 However, systemic propranolol carries a risk of serious adverse effects including bradycardia, arrhythmias, hypotension and hypoglycaemia.6 Children with PHACES syndrome may have cerebrovascular anomalies and oral propranolol can be a contraindication in these patients owing to the risk of cerebral ischaemia.6 The use of another beta blocker, topical timolol, was reported in the treatment of a thin eyelid haemangioma.7 To the best of our knowledge, this therapy has not been previously reported in the treatment of a large ulcerating haemangioma with PHACE syndrome.