Angiofibromas are the most recognized cutaneous manifestations of
tuberous sclerosis complex.
Angiofibromas can be associated with disfigurement,
bleeding,
pruritus, and
erythema and may lead to significant psychosocial consequences for affected patients. Histopathologically,
angiofibromas consist of a mixture of vascular and interstitial cells. Traditional treatment options include
cryotherapy,
electrocoagulation,
radiofrequency ablation,
dermabrasion,
laser treatment, and topical agents such as
podophyllotoxin. However, complications such as
pain, postinflammatory
hyperpigmentation,
scarring, and the frequent recurrence rate reduce the utility of these treatment options. The introduction of topical
rapamycin marked a turning point for treatment of facial
angiofibromas; however, the lack of a standardized formulation, limited insurance coverage, and significant financial cost restrict universal access for patients and their caregivers. Both oral and topical β-blockers have proven extremely effective treatments for superficial vascular
tumors such as
hemangiomas and pyogenic
granulomas. Topical β-blockers may potentially be useful for treatment of
angiofibromas considering these lesions also contain a vascular component. Here we present an exploratory case report of a patient with
tuberous sclerosis complex who had significant clinical improvement of her facial
angiofibromas utilizing a "split-face" comparison protocol of topical
timolol 0.5% gel after full-field treatment with ablative fractional
laser resurfacing and
pulsed-dye laser.