Hemangiomas are benign (not cancer) collections of extra blood vessels in the skin and are one of the most common skin growths of the first year of life. They appear most frequently during the first one to four weeks after birth and occur in about 5% of all children. Hemangiomas may look different depending upon how deep they are in the skin. More surface (superficial) hemangiomas tend to be bright red and raised with an uneven surface. Deeper hemangiomas tend to be smooth on the surface, and may be skin-colored or sometimes blue in coloration. Often, both superficial and deep parts will be present (sometimes referred to as a mixed hemangioma). Not infrequently, superficial types of hemangiomas will begin as flat pink areas that rapidly change into raised, bright red growths.
Hemangiomas usually grow most in the first 3-4 months of life. Later, usually around 6-18 months, they then begin to slowly get better. This improvement phase – called involution – occurs more slowly than the growth phase. Most hemangiomas have begun to involute significantly between 1 and 3 years of age and many are significantly better by the time children reach Kindergarten.
Because all hemangiomas undergo involution, treatment is not needed in every case. Some hemangiomas, particularly those which do not involve the face, may not require any treatment, but others do. Reasons for treatment may include cosmetic concerns, ulceration (breakdown of the skin over the hemangioma), or less commonly when the location of a hemangioma causes problems with eating, vision, hearing or breathing. A number of treatment options are available. These include oral (by mouth) medications (such as propranolol or steroids), cortisone injected directly into the hemangioma, topical (applied to the skin of the hemangioma) medications (such as clobetasol or timolol), laser therapy and surgery. The choice of which treatment is best depends on the child’s age, location of hemangioma, size of the hemangioma and other considerations. Infants with hemangiomas, especially those causing problems or needing treatment, are usually seen frequently by their doctor during the first year. After this, doctor visits usually occur less often.