Efficacy of topical timolol versus saline in chronic venous ulcers: A randomized controlled trial

Background: Chronic venous ulcers sometimes fail to heal in spite of adequate treatment. Nonhealing is possibly because of chronic activation of β-2 adrenergic receptor (B2-AR) in the keratinocytes by endogenously generated catecholamines, which inhibits keratinocyte migration. Blocking of B2-AR using β-blockers has been reported to promote wound healing through keratinocyte migration, angiogenesis, and fibroblast migration. Topical timolol, a B2-AR antagonist, is used to promote wound healing. Aims and Objectives: The aim of this study was to compare the efficacy of topical timolol versus saline in chronic venous leg ulcers and to compare the mean reduction in ulcer area at the end of 4 weeks. Materials and Methods: Twenty patients were randomized into two groups. Patients in Group 1 were treated with one drop of 0.5% topical timolol every alternate days for 4 weeks. Ulcer margins were measured and ulcer area calculated every week for 4 weeks. Similar dressing and measurement were carried out for patients with saline for 4 weeks. Healing rate was assessed by the percentage of reduction of ulcer area of both groups at week 4. Results: The mean reduction in the ulcer size in timolol group was 86.80%, and in saline group 43.82% at the end of 4 weeks. Conclusion: Topical timolol is an easy, noninvasive therapy that can be recommended for chronic ulcer.