Hemangiomas: What You Should Know About Your Baby’s Birthmark
Key takeaways:
Hemangiomas are a type of birthmark that appear at birth or shortly thereafter. They’re made of an enlarged tangle of blood vessels.
Infantile hemangiomas fade and disappear during childhood. But medications can help them fade faster.
Some hemangiomas can lead to more serious health conditions due to their size or location on the body.
When your baby was born, you probably took some time to learn every nook and cranny of their little, new body — their downy hair, wrinkly feet, and soft ears. And maybe you noticed a birthmark or two.
One common birthmark is an infantile hemangioma. In fact, about 5% of babies have an infantile hemangioma. These types of hemangiomas are usually harmless and fade over time. But there are treatments for them. And some of them need more careful medical attention — especially if they’re on your baby’s face or over the spine.
If your baby has an infantile hemangioma, here’s what you need to know to help you decide about treatment and when to get extra medical attention.
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What are the symptoms of a hemangioma?
An infantile hemangioma looks like a raised, bumpy area of skin. They’re often reddish but can also look purple. Sometimes people call them “strawberry hemangiomas” because of their color and bumpy appearance. Infantile hemangiomas are fragile — they tend to bleed easily, even with minor trauma.
Usually they take a few weeks to appear. They show up more often in females and infants who were born prematurely. They tend to grow rapidly in the first 9 months of life then fade and even during childhood. Once they fade, they may leave a faint mark, pale skin, a lump, or wrinkles.
Hemangiomas may be present at birth — congenital hemangiomas — but these are less common.
What causes a hemangioma?
Hemangiomas are a tangle of overgrown blood vessels. They’re often referred to as a tumor, but they aren’t cancerous and they won’t turn into cancer. The term “tumor” in this situation just means a “growth.”
It’s not clear why some babies get hemangiomas. The development of blood vessels is a complex process that relies on multiple genes, proteins, and hormones. It’s likely that changes in these steps lead to hemangiomas.
How do you diagnose a hemangioma?
Most of the time, it’s enough to look at a hemangioma to diagnose it. That’s because hemangiomas look very different from other types of birthmarks.
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Imaging can help when it’s not clear if a birthmark is a hemangioma. An ultrasound or MRI can show what a birthmark looks like on the inside. If the pictures show a tangle of blood vessels — that confirms a birthmark is a hemangioma.
Should I be worried about a hemangioma?
Hemangiomas are usually harmless and don’t cause any damage. But these hemangiomas need special attention:
Eyelid hemangiomas: Hemangiomas near the eyes can lead to amblyopia, or vision loss. Without treatment, half of children with these hemangiomas develop vision problems.
“Beard” (segmental) hemangiomas: These cover part of the face in the same distribution as facial hair. They may look like a beard on one side of the face. Children with these types of hemangiomas may have PHACES syndrome.
Lower back hemangiomas: Hemangiomas on the lower back can be a sign of LUMBAR syndrome.
Multiple hemangiomas: Infants with five or more skin hemangiomas are at higher risk of having hemangiomas inside their organs, especially in the liver. Hemangiomas inside the liver can lead to heart failure and hypothyroidism if they aren’t treated.
Congenital hemangiomas: While they look like infantile hemangiomas, congenital hemangiomas are different in some important ways. They may get very large and lead to other medical problems. And they don’t always fade on their own.
If your child has any of these, talk to their healthcare provider. Your child may need additional tests and specialized treatment for their hemangiomas.
What are the treatments for hemangiomas?
If your baby has a hemangioma, there are many options for treatment. But not all treatments may be right for your child. It’s a good idea to work with a specialist who is familiar with treating hemangiomas.
Treatment options include:
Beta blockers: Beta blockers are a well-known treatment for high blood pressure. But in 2008, researchers found they can also shrink hemangiomas quickly and safely. Beta blockers are now the first-choice treatment for hemangiomas, and they’re safe even for very young infants. Propranolol is available in a liquid form, and children take it by mouth. Timolol comes as a drop that you can apply directly to the hemangioma, usually twice a day.
Steroids: Steroids can help slow the growth of hemangiomas and make them shrink. They’re currently a second-choice treatment. You can apply steroids directly to the hemangioma, like hydrocortisone cream, or inject them into the hemangioma. Sometimes children take oral (by mouth) steroids as treatment.
Other medications: In rare cases, other medications, like vincristine, interferon-α, and imiquimod, can treat hemangiomas. These medications can lead to serious side effects. So they’re only used in specific situations.
Laser therapy: Laser therapy can treat hemangiomas, especially those on the face or ones that bleed often. Laser therapy can also help treat telangiectasias (dilated blood vessels) that can remain after a hemangioma has faded.
Surgery: Surgery is an uncommon treatment for hemangiomas because of the risks of general anesthesia and scarring after surgery.
What happens if you don’t treat the hemangioma?
Not all hemangiomas need treatment. In fact, 2 out of 3 infantile hemangiomas go away on their own.
But your child should get treatment as soon as possible if they have a concerning hemangioma, such as one near the eye or inside an internal organ, like the liver. Without treatment, these hemangiomas can lead to more serious medical problems.
If your child has an infantile hemangioma on their face, you might also consider treating it. Hemangiomas can bleed and get infected, and this increases the risk of scarring.
Treating a hemangioma makes it fade faster, so there’s less opportunity for it to get infected or traumatized. This can help reduce the risk of scarring — which is often more noticeable on the face. If your baby is prone to scarring, you might consider early treatment regardless of the location of the hemangioma.
The bottom line
Hemangiomas are a type of birthmark. They’re made up of a tangle of overgrown blood vessels. About 5% of all babies develop a hemangioma. Most will go away on their own or with medication, like propranolol or timolol. In rare cases, hemangiomas lead to other medical problems because of their location on the body or their rapid growth.
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References
Darrow, D. H., et al. (2015). Diagnosis and management of infantile hemangioma. Pediatrics.
Haggstrom, A. N., et al. (2006). Prospective study of infantile hemangiomas: Clinical characteristics predicting complications and treatment. Pediatrics.
Horii, K. A., et al. (2011). Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas. Pediatric Dermatology.
Kilcline, C., et al. (2008). Infantile hemangiomas: How common are they? A systematic review of the medical literature. Pediatric Dermatology.
Léauté-Labrèze, C., et al. (2008). Propranolol for severe hemangiomas of infancy. New England Journal of Medicine.
Marchuk, D. A. (2001). Pathogenesis of hemangioma. The Journal of Clinical Investigation.
Wassef, M., et al. (2015). Vascular anomalies classification: Recommendations from the International Society for the Study of Vascular Anomalies. Pediatrics.
