The efficacy of topical timolol for the treatment of recalcitrant fissures and erosions in patients with chronic hand eczema was supported in a short communication published in the Journal of the American Academy of Dermatology.
A dermatologist at a skin clinic in Nashik, India, Manoj Pawar, MD, described the use of topical timolol in a 45-year-old man with chronic persistent hand eczema. The patient’s fissures and erosions had not responded to prior treatment with topical clobetasol dipropionate, topical tacrolimus, or oral methotrexate. Dr Pawar provided the patient with timolol 0.5% ophthalmic solution, which he was instructed to apply to each fissure/erosion at bedtime. The patient was also advised to avoid exposure to irritants. At 1 week of follow-up, erosions and fissures had healed significantly; only slight “scales” were present. The patient also reported a proportionate decrease in pain. The patient was instructed to continue therapy for 1 month, during which there was no recurrence of fissures and lesions.
Based the results from this patient, topical timolol may be an effective treatment option for patients who do not respond to other eczema treatments. Timolol is also substantially cheaper than other methods, such as tacrolimus or methotrexate.
The short follow-up period is a limitation to this analysis; further study of timolol is necessary to assess the long-term effects.
The clinician also advised against timolol use in patients with underlying cardiovascular comorbidities. As a nonselective beta blocker, timolol may have unanticipated effects on heart function. The mechanism by which timolol heals eczema lesions remains unclear; Dr Pawar hypothesized that beta blockers increase keratinocyte migration, thus accelerating skin wound healing. Although topical timolol for hand eczema requires further study, the present results support its efficacy for lesion healing and pain reduction.
Pawar M. Topical timolol in chronic, recalcitrant fissures and erosions of hand eczema [published online April 22, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.04.070