Beta-blockers

Timolol maleate ophthalmologic gel or gel forming solution is used off-label for the treatment of thin, small, non-ulcerated infantile hemangiomas. It can also be used for pyogenic granulomas. Timolol maleate 0.5% is applied 1 drop to the affected area twice daily.

Cyanoacrylate

Cyanoacrylate is the main ingredient in Dermabond and is also the primary adhesive in some “superglues” available for industrial or household use. Cyanoacrylate adhesives can be used to seal fissures on fingertips and soles of the feet in order to decrease the pain and the chance of infection. Care should be taken to ensure that skin is clean prior to application of adhesive and that adhesive is completely dry before anything comes in contact with treated skin.

Aluminum chloride

Aluminum chloride can be used topically to treat hyperhidrosis. It is available over the counter as 6.25-20% solutions. This is applied nightly to affected areas until sweating decreases and then used once or twice weekly for maintenance. It is also used as a chemical cauterant and is useful for shave biopsies or after injections to control small amounts of bleeding.

Lidocaine/Prilocaine Eutectic mixture

Topical anesthetics are useful for pre-treatment of biopsy or injection sites in children. Some can be purchased over the counter and should be applied under occlusion 60 minutes prior to the procedure and the anesthetic effect lasts for approximately 1-2 hours after removal. Such topical anesthetics should only be used on intact skin and on small surface areas. Prilocaine has a risk of methemoglobinemia if used on large surface areas.