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. The term “infantile hemangiomas” or “hemangioma of infancy” refers specifically to the most common form of hemangioma in infants and young children. In the past, hemangiomas have been called “strawberry hemangiomas,” “cavernous hemangiomas,” or “capillary hemangiomas,” but these terms have fallen out of favor.

No. Although it is considered to be a tumor, it is BENIGN, not malignant (i.e. this is not cancerous).

No.

Vascular anomalies are divided into two categories: 1 Growths Infantile hemangiomas are a type of growth, meaning that they grow faster than the rest of the child. 2 Vascular malformations Vascular malformations are often noted at birth and typically grow in proportion to the child. Some examples of malformations are port-wine stains and venous malformations. These are completely different from infantile hemangiomas, and are treated differently as well.

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 ( referred to as a “mixed hemangioma”). Often more superficial hemangiomas begin as flat pink areas or are mistaken for a bruise or a scratch. They usually change rapidly becoming bright red and growing in volume. As hemangiomas began to involute (get smaller), their appearance changes. They develop milky white areas within them, become softer, and eventually fade, over a period of a few years.

Although only 1 to 2.6 percent of newborn infants have hemangiomas present at birth, they are found in up to 4% of infants, appearing 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 the product of a multiple gestation. There is also an increased risk of hemangioma in babies born to mothers of advanced maternal age, and those with a history of placental problems or high blood pressure (pre-eclampsia) during the pregnancy. Having a family history of hemangioma also slightly increases the risk of having a baby with a hemangioma. While there has been an association with a form of prenatal testing known as CVS (chorionic villus sampling), most babies born after a mother gets CVS do not get hemangiomas.

It is not completely understood why hemangiomas occur. There are no known associations between maternal diet, behaviors or environment. There are no known ways of preventing a hemangioma from developing. Parents should not feel guilty or responsible for their child’s hemangioma. We are continuing to learn more about hemangiomas through research. We know that hemangiomas are growths of very immature blood vessels which are different from the normal blood vessels of the skin. They most resemble blood vessels of the placenta with a similar chemical profile including the presence of a marker called GLUT-1. This marker is sometimes used to distinguish infantile hemangiomas from other vascular tumors or malformations.

At birth, hemangiomas are usually absent or barely noticeable as a “precursor” spot, which may resemble a red discoloration, bruise, or area of minor trauma such as a scratch-mark. The growth phase varies from one hemangioma to another, even in the same child. Typically within a days to weeks hemangiomas often become bright in color and more elevated. This usually occurs between 1 and 5 months. The fastest growth is often seen in the first 4 to 8 weeks of life, but there are many exceptions and some hemangiomas, especially those which are located deeper in the skin can growth for several more months. Hemangiomas begin to slowly resolve ( also known as “involution”). This improvement occurs even in hemangiomas which get no treatment. This phase is usually much slower than the growth phase. It can begin as early as 6 months and continue up until age 4 or 5 years, occasionally longer. Some hemangiomas, even after involution, can leave behind small dilated blood vessels or discolored, or stretch-mark like skin. By age 4 or 5 years it is possible to tell whether there will be any permanent skin changes and if so, what treatment options are available for these changes.

In deciding whether there is a need for active treatment it is important to recognize that hemangiomas - on their own - will improve. It is important to weigh the potential risks and benefits of treatment compared to the outcome that might occur if the hemangioma is left to resolve on their own. This decision will depend on many factors including how old your baby is, the location and size of the hemangioma, how quickly it is growing or if it has stopped growing, and whether it is causing or could possibly cause a problem. When considering treatment, you and your baby’s doctor should take all of these factors as into account. Reasons for treatment may include a raw open area developing (this is called “ulceration”, the possibility that the hemangioma might leave skin changes in a location such as the face, that could impact psychological well-being, and problems with vital functions (including eating effectively, normal development of vision and hearing, breathing, etc). These and other possible reasons treatment might be needed should be discussed with your baby’s doctor. Children with hemangiomas that cause problems should be followed carefully by a specialist, such as a pediatric dermatologist (skin doctor for children) or other specialists with advanced knowledge and training about hemangiomas. Most hemangiomas are considered “low-risk” and are unlikely to cause problems. Examples include smaller hemangiomas in areas easily covered by clothing. For these low-risk hemangiomas, intermittent observation by your pediatrician or family doctor is most appropriate. It may be helpful to take frequent pictures of the hemangioma(s) over time and bring these photos to your appointments so your physician can see how the hemangioma is changing.

For those hemangiomas needing treatment, the main treatment options used are beta-blocker medications. Propranolol, an oral beta-blocker is approved by the the United States, Canada, and many other countries for the treatment of hemangiomas. It is usually given for at least 6 months. Timolol, a beta-blocker eye drop, is often used for flat hemangiomas that might need treatment but are not as fast-growing, bulky, or worrisome as those that need oral medication. Other treatment options including oral or injected cortisone, laser, and surgery are options used less often but can be discussed with your doctor. The choice to use one of these treatments is best involves the location, age, size and other factors. For more information, view the Treatments Section. See also Homepage (https://www.hemangiomaeducation.org) for the "Propranolol: Educational Video for Caregivers" to learn more about it if your provider is recommending propranolol treatment for your child's hemangioma.

As children get older, they may become more aware of their hemangioma. Most children younger than aged 3 or 4 years are not worried about their hemangioma. For older children it is helpful to teach them the word “birthmark” or “hemangioma” so that if someone asks about their hemangioma, they can respond that “that is my birthmark - I was born with it”. A critical time to talk to your child is often when they are beginning kindergarten, when friends or teachers may ask about it. The “explain-reassure-distract” technique if often helpful in this situation (See https://www.changingfaces.org.uk/). The reassurance is that it is not contagious, painful, or a sign of trauma, and that your child is otherwise fine. Thereafter you can change the subject. Ask your doctor for tips for talking to your child and about their hemangioma and how to cope with any questions about it.

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. If you are having a particularly difficult time or the situation is causing depression or severe anxiety, getting help from a mental-health professional can be helpful.