Infantile Hemangiomas – Frequently Asked Questions
What is a hemangioma?
Hemangiomas are growths and collections of extra blood vessels and blood vessel cells in the skin and are one of the most common skin problems in the first year of life.
The terminology for hemangiomas can be confusing. A more specific term for these lesions is “infantile hemangioma” or “hemangioma of infancy”. In the past, hemangiomas have been called “strawberry hemangiomas,” “cavernous hemangiomas,” or “capillary hemangiomas,” but these terms have fallen out of favor.
Are hemangiomas cancerous?
No. Although it is considered to be a tumor, it is BENIGN, not malignant (i.e. this is not cancerous).
Are hemangiomas contagious?
How is a hemangioma different from other kinds of birthmarks?
Vascular anomalies are divided into two categories:
- Infantile hemangiomas are a type of growth, meaning that they grow faster than the rest of the child.
- Malformations, on the other hand, are present at birth and grow in proportion to the child. Some examples of malformations are port-wine stains and venous malformations. These are clinically different than hemangiomas, and are treated differently as well.
What do hemangiomas look like?
Hemangiomas may have different appearances, depending upon the depth of the blood vessels and the stage of growth.
Superficial hemangiomas tend to be bright red and elevated with an uneven surface. Deep hemangiomas tend to be smooth on the surface, but blue in coloration. Many times, both superficial and deep (red and blue) components will be present together in the same hemangioma (this is referred to as a “mixed hemangioma”). Not infrequently, the more superficial types of hemangiomas will begin as flat pink areas, but rapidly change into the elevated bright red lesions. They often are mistaken initially as a bruise or a scratch. Hemangiomas look different as they grow, involute (get smaller), and eventually resolve.
Who gets hemangiomas?
Although only 1 to 2.6 percent of newborn infants have hemangiomas present at birth, they are found in up to 10 percent of patients by 2 years of age, and appear most frequently during the first one to four weeks of life.
Hemangiomas are more common in babies who are female, premature, fair skinned, lower birth weight (less than 3 pounds) or have a history of prenatal testing known as CVS (chorionic villus sampling). It is important to note that although there is an association between CVS and hemangiomas, getting CVS does not mean your child will develop a hemangioma, and most hemangiomas are not caused by CVS. There may also be an increased risk of hemangioma in babies born to mothers of advanced maternal age, and those who had a history of some placental problems or high blood pressure during the pregnancy.
Why does my child have a hemangioma?
It is not well understood why hemangiomas occur. There are no known associations between maternal diet, environment, or behaviors. Parents should not feel guilty or responsible for their child’s hemangioma. There are no known ways of preventing a hemangioma from developing.
Much research is currently being devoted to understanding hemangiomas in more detail. Hemangiomas probably form very early in the development of the fetus, during the first trimester. It is known that the blood vessels that comprise hemangiomas are different from those typically found in the skin. Hemangioma vessels do resemble vessels found in the placenta, and express similar proteins to those found in the placenta (such as GLUT-1, merosin, Lewis Y antigen, and FcYRII).
What will happen to my child’s hemangioma?
Hemangiomas go through a predictable but highly variable cycle of four phases – nascent (resting), proliferating (growing), involuting (shrinking or going away) and involuted (resolved or gone). Only about 50% of babies have a “precursor” mark at birth, often resembling a bruise or scratch. After the nascent phase for the first few weeks after birth, hemangiomas typically tend to enlarge in size between 1 month and approximately 5 months of age (proliferating phase). They reach a plateau phase where growth stops by five to six months of age, but sometimes they may still grow beyond 6 months of age.
Hemangiomas begin to slowly resolve (“go away”) between 1 and 3 years of age (involution). Approximately 50 percent of hemangiomas resolve by 5 years of age, and 10% per year (60% by age 6, 70% by age 7, etc.) with continued involution until 12 years in most cases. However, there can be marked variation in the rate and degree of growth and involution. For example, some hemangiomas can grow quite rapidly, while others do not grow much at all. It is not uncommon for there to be residual blood vessels or discolored, redundant or loose skin left behind where the hemangioma was.
We certainly encourage you to feel good about the probability of resolution of your child’s hemangioma.
Does my child’s hemangioma need treatment?
As with all medical interventions, one must weigh the potential risks and benefits of treatment. Because of the natural history of eventual resolution of these lesions, we rarely need to medically intervene with aggressive therapy. When considering treatment, your baby’s doctor will take into account his/her age, location of the hemangioma on the body, hemangioma size, rate of growth, and other factors.
Reasons for treatment may include situations of severe ulceration (an open sore), potential for long-term disfigurement and problems with vital functions (including eating effectively, normal development of vision and hearing, breathing, etc). If a hemangioma grows very rapidly to a large size or becomes ulcerated, it may leave permanent scarring. There are some other rare situations that also require immediate intervention.
Children with hemangiomas that cause problems should be followed carefully by a specialist, such as a pediatric dermatologist (skin doctor for children) or other vascular anomalies specialist. For non-worrisome hemangiomas, intermittent observation by your pediatrician or family doctor is most appropriate. It may be helpful to take frequent pictures of your child as he or she develops. Bring these photos to your appointments so your physician can see how the hemangioma is changing.
What treatments are available?
Most hemangiomas do not require medical therapy, and are often watched clinically. When treatment is required, the most common means of intervention are oral, topical or injected steroids, oral propranolol, topical timolol, laser and surgery. In severe or refractory cases, other medications may need to be used. The choice to use one of these various techniques involves the location, age and appearance of the lesion. Unfortunately, there is no “cure” for hemangiomas. For more information view the Treatments Section.
What do I say when my child asks about his or her hemangioma?
As children get older, they may become more aware of their hemangioma. A critical time tends to be entry into kindergarten, when friends or teachers my wonder about why your child may look different. We advise parents to tell their children that they have a birthmark, it is not contagious, and that they are completely normal kids. Ask your doctor for tips for talking to your child and about their hemangioma and how to cope with any questions about it. It is very important that your child be treated as a normal child.
How can I, as a parent, work through my own emotions regarding my child’s hemangioma?
Having a child with a hemangioma can have a significant impact on the family. In particular, hemangiomas which are visible or on the face are sometimes met with stares, questions, and even accusations of child abuse. You are not alone. Discuss these issues with your family, teachers, and doctors. Your baby’s specialist may also be able to put you in touch with other families of children who have (or have had) hemangiomas.