Hypergranulation is a frequent complication of dermatologic surgery,
especially when surgical defects are left to heal by secondary intention
(eg, after electrodesiccation and curettage). Although management of
postoperative hypergranulation with routine wound care, superpotent
topical corticosteroids, and/or topical silver nitrate often is
effective, refractory cases pose a difficult challenge given the paucity
of treatment options. Effective management of these cases is important
because hypergranulation can delay wound healing, cause patient
discomfort, and lead to poor wound cosmesis.Timolol powder
If refractory hypergranulation fails to respond to treatment with
routine wound care and topical silver nitrate, we prescribe twice-daily
application of timolol maleate ophthalmic gel forming solution 0.5% for
up to 14 days or until complete resolution of the hypergranulation is
achieved. We counsel patients to continue routine wound care with daily
dressing changes in conjunction with topical timolol application.
We initiated treatment with topical timolol in a patient who developed
hypergranulation at 2 separate electrodesiccation and curettage sites
that was refractory to 6 weeks of routine wound care with white
petrolatum under nonadherent sterile gauze dressings and 2 subsequent
topical silver nitrate applications (Figure 1). After 2 weeks of
treatment with topical timolol, resolution of the hypergranulation and
re-epithelialization of the surgical sites was observed (Figure 2).
Another patient presented with hypergranulation that developed following
a traumatic injury on the left upper arm and had been treated
unsuccessfully for several months at a wound care clinic with daily
nonadherent sterile gauze dressings and both topical and oral
antibiotics (Figure 3A). After treatment for 9 days with topical
timolol, resolution of the hypergranulation and re-epithelialization of
the surgical sites was observed (Figure 3B).
Beta-blockers are increasingly being used for management of chronic
nonhealing wounds since the 1990s when oral administration of
propranolol initially was reported to be an effective adjuvant therapy
for managing severe burns.1 Since then, topical beta-blockers have been
reported to be effective for management of ulcerated hemangiomas, venous
stasis ulcers, chronic diabetic ulcers, and chronic nonhealing surgical
wounds; however, there are no known reports of using topical
beta-blockers for management of hypergranulation.2-5 We found timolol
ophthalmic gel to be an excellent second-line therapy for management of
postoperative hypergranulation if prior treatment with routine wound
care and superpotent topical corticosteroids has failed. To date, we
have found no reported adverse effects from the use of topical timolol
for this indication that have required discontinuation of the
medication. Use of this simple and safe intervention can be effective as
a solution to a common postoperative condition.
