These birthmarks are non-cancerous tumors that almost always cause no problems aside from their appearance. They also usually go away without treatment.
Hemangiomas can also occur inside the body. Another article will look at these in more detail.
Doctors may call vascular birthmarks "infantile hemangiomas." They almost always appear within the first few weeks of infancy, although only about 1 in 10 hemangiomas are on babies at birth. Some take longer to show because they are deeper in the skin.
Hemangiomas are the most common type of tumor in infants. Another estimate shows the benign tumor affects about 5 percent of children. White children, especially girls, are more likely to get the lesion.
Within 3 to 5 months of age, 80 percent of hemangiomas reach their maximum size. Most others peak before 1 year.
Hemangiomas can develop anywhere on the skin, but they most often affect the head, neck, and trunk. They most often appear on the face around the cheek, lips, or upper eyelids.
What are hemangiomas? What do they look like?
Hemangiomas appear red near the surface of the skin. Deeper in the skin, hemangiomas look bluer. They look this way because hemangiomas are growths of excess blood vessels.
The ones nearer the surface involve the tiny blood vessels called capillaries. Some people give these lesions the name "strawberry mark" because of their bright red appearance.
Hemangiomas are often found in children and usually go away in time.
These hemangiomas may be warm to the touch because of the extra blood vessels near the surface.
All skin hemangiomas form because of an overgrowth of blood vessels, creating an abnormal lump. There is a wide variety of shapes and sizes.
These birthmarks are usually single lesions, and usually in a definite shape. Less often, single lesions are broader and have more of a broken-up shape. More rarely still, they can be in multiple places on the skin.
The size of the tumors varies a great deal between different people. Some are very small, and some can be spread over a wide area.
After the birthmark first appears, its size and amount of blood vessel supply increases rapidly. The hemangioma then settles and stays for several years before shrinking.
The Hemangioma Investigator Group published a study in the journal Pediatrics involving 1,058 children under 12. The children had a total of 1,915 hemangiomas between them. The study found that:
- Just over two-thirds had a single hemangioma, and just 3 percent of the children had more than six
- 41 percent were on the face, 21 percent elsewhere on the head and neck, 23 percent on the trunk, 18 percent on the extremities, and 6 percent around the private areas
- Of the ones that were classified, 67 percent had a definite shape, 13 percent had a broken-up shape, and less than 4 percent were in multiple places
- The average size for single hemangiomas was 19 square centimeters
Diagnosis and treatment of hemangioma birthmarks
Doctors diagnose this type of birthmark just by how they look. Most cases do not need further investigation or treatment.
Hemangiomas go away on their own between the ages of about 5 and 10 years. This means they shrink and disappear, most commonly before the age of 7.
They can sometimes leave areas of slightly lighter skin, or small blood vessels, or stretched skin showing wrinkling. Depending on the location, they can sometimes leave a slight distortion. Any lasting marks that cause a problem can often be improved with plastic surgery.
Minor scrapes on the skin are more likely to lead to bleeding or ulcers where the marks are. Ulcers can be painful and are more likely to leave a scar after the hemangioma has gone.
People should take care with hemangiomas to avoid getting them scratched and scraped. The following tips can help:
Doctors may recommend drug treatments if a hemangioma causes problems. Surgery is avoided where possible.
- Stopping them from drying out by avoiding soaps and using plain, protective creams
- Keeping the marks out of the sun
- Using a high-factor sunscreen
- Getting any ulcers checked so that infections can be spotted early and treated
- Bathing ulcers regularly with plain warm water and avoiding rubbing them
- Leave ulcers to dry naturally before covering them with a non-sticky dressing
- Applying firm pressure with a clean cloth for at least 5 minutes if a lesion starts to bleed
- Getting medical help if the bleeding does not stop
Treatment for complicated hemangiomas
If the lesions are causing problems, doctors may recommend drug treatment to help reduce them more quickly.
In some cases, hemangiomas can cause problems because of their location. Rare types of birthmark affect the eye so much that they need treating immediately to avoid eyesight problems:
- Eyelid hemangiomas can put pressure on the surface of the eye and cause reduced vision to develop in a baby. They can also block eyesight by causing the eyelid to droop
- If one of these tumors is in the area around the eye, the pressure on the eye can affect eyesight or even press on the optic nerve
Eye doctors use the same treatment options for these hemangiomas as other doctors do for elsewhere on the skin. They may also use eye treatments.
Another rare type of hemangioma can obstruct the airway. Those forming around the outlets for urine or stool might affect emptying the bladder or bowel.
Surgery is avoided in all but the most necessary cases. This is because surgery has the risks of anesthetic. The skin is also likely to look worse after an operation than after the birthmark being left to disappear on its own. If surgery is needed, different types of laser surgery can be used.
Propranolol is the main drug used to treat hemangiomas.
The main option for treating hemangiomas that are causing problems is a drug known as propranolol.
Some children cannot take this tablet. Instead, they may get corticosteroids, which can be taken by mouth or applied directly to the skin. Children with conditions such as asthma cannot take propranolol.
Propranolol is a type of drug known as a beta-blocker. It is usually used for heart conditions but was found to stop the growth of hemangiomas.
The doctors who first tested this effect tried the drug in a number of children with severe facial hemangiomas. With propranolol treatment, these birthmarks went from intense red to purple. They also went from hard to softer lesions, then continued to improve until they were flat.
Propranolol was given official approval in 2014 for treating hemangiomas. It is reserved for only the complicated cases of hemangioma because it has side effects.
Propranolol treatment may be given while a child is in a hospital. The drug is monitored in all cases, especially at the beginning of treatment. This is because of the potential effects on heart rate and blood pressure.
Corticosteroids also need to be used with care because of potential side effects.
Other syndromes involving hemangiomas
Rarely, children with a large hemangioma have one or more abnormalities - of the brain, heart, blood vessels, or eye - that mean they are diagnosed with PHACE syndrome. This hemangioma is usually on the face or neck. It is uncommon and more likely in girls than boys.
Hemangiomas can also grow with two other syndromes: PELVIS and LUMBAR syndromes. Like PHACE syndrome, these show other abnormalities alongside the hemangioma.