All you need to know about external hemangiomas
Also known as vascular birthmarks or infantile hemangiomas, they usually cause no problems aside from their appearance and often go away without treatment.
Sometimes, a person has another condition as well as the hemangioma.
External hemangiomas appear as a red mark near the surface of the skin. Some people call them a "strawberry mark" because of their bright red appearance.
Hemangiomas can also occur inside the body, but this article looks at those that appear on the skin.
What are hemangiomas?
People sometimes call a hemangioma a strawberry mark because of its bright red color.
A hemangioma is a kind of benign tumor that affects the blood vessels. It happens when too many blood vessels develop.
Hemangiomas tend to appear within the first few weeks of infancy. Some take longer to show because they are deeper in the skin.
The most rapid growth of superficial infantile hemangiomas usually occurs between the ages of 1–3 months.
They usually reach 80% of their total size by 3 months of age and most finish growing by the age of 5 months.
Typically, they start to get smaller when a child is about of 12 to 15 months old and most resolve between the ages of 3 and 10.
Hemangiomas can develop anywhere on the skin, but they most often appear on the head, neck, and trunk. Some people will experience complications, such as pain and ulceration.
It is unclear exactly how common hemangiomas are, but one estimate suggests they affect 4–10 percent of babies.
Female infants are more likely to have a hemangioma than male babies, they are more common in Caucasian children, and preterm babies have a higher chance of developing one than full-term babies.
The depth, size, shape of the mark will vary.
There are different types of hemangioma.
Hemangiomas are common in infants and usually go away without treatment.
Capilliary hemangiomas appear near the surface of the skin. They occur when lots of tiny blood vessels called capillaries develop. Connective tissue holds these capillaries together. If the group of blood vessels is large, the hemangioma may be slightly raised and have a spongy texture. This is the type that is most likely to affect a baby.
Cavernous hemangiomas affect blood vessels in the deeper layers under the skin. They occur when larger blood vessels dilate, or widen. These blood vessels are not packed together very tightly, and a cavernous hemangioma develops when blood fills the spaces between the blood vessels.
A lobular capillary hemangioma is when there are so many blood vessels that they form a lump. This type of hemangioma can bleed easily.
People aged over 30 years often develop a cherry angioma, also known as a Campbell de Morgan spot. Click here to find out more.
Other types of hemangioma can occur inside the body, for example a liver hemangioma.
Size and shape
Some hemangiomas are small, while others cover a wide area.
Hemangiomas usually present as a single lesion with a definite shape. Sometimes, a single lesion may be broader with a more broken-up form. Rarely, they can appear in multiple places on the skin.
After the hemangioma first appears, its size and the amount of blood vessel supply increases rapidly. It then tends to settle. After several years, it often begins to shrink.
A hemangioma does not usually cause complications, but the following are possible, depending on the type:
- bleeding after a scratch
- ulceration in 5-25 percent of cases
- problems with blood clotting
Bleeding: If a person with a hemangioma has a minor scrape or a cut that affects the skin close to where the mark is, it might cause bleeding.
Ulceration: Sometimes an ulcer can form. This can be painful, and a scar may remain after the hemangioma disappears. A doctor may prescribe antibiotics to prevent infection.
A hemangioma that forms on the lips can cause ulcers to develop. These can take time to heal. An ulcer can disrupt feeding because it will be painful. Putting some petroleum jelly on the teat of the baby's bottle, on the nipples if the baby is breast-feeding, or on the lips, may ease the discomfort. A doctor may recommend medication.
Eye problems: If a hemangioma develops around the eye, it may put pressure on the eye and stop it from developing properly. There may be a risk of eye problems, such as amblyopia or glaucoma. A doctor will treat the hemangioma as soon as possible to reduce this risk.
Other conditions: Sometimes, a hemangioma is a sign of a syndrome that affects other parts of the body, for example, the brain, heart, blood vessels, or the eye.
A doctor may continue to monitor the child as they grow up to check for further symptoms.
Although a hemangioma is a kind of tumor — a vascular tumor — information published by the Pediatric Treatment Editorial Board note that it rarely spreads. In other words, it is unlikely to become cancerous.
Diagnosis and outlook
A hemangioma can form a lump if there are many extra blood vessels.
A doctor can usually diagnose a hemangioma by looking at it. Typically, they do not require any further investigation or treatment.
Hemangiomas usually shrink and disappear when a child is around 5–10 years old.
After they disappear, they may leave:
- an area of slightly lighter skin
- small blood vessels
- stretched skin showing wrinkling
- a slight distortion in the skin
Cosmetic surgery can often improve any unwanted effects.
People should take care to avoid scratching or scraping a hemangioma, as this can lead to bleeding or the formation of an ulcer.
The following tips can help:
- stop the area from drying out by avoiding soaps and using plain, protective creams
- keep the mark out of the sun
- use a high-factor sunscreen
- see a doctor if an ulcer forms or other changes occur
If a hemangioma starts to bleed:
- apply pressure with a clean cloth for at least 5 minutes
- get medical help if the bleeding does not stop
If an ulcer forms:
- seek medical help
- bathe the area regularly with plain warm water and avoid rubbing it
- leave the ulcer to dry naturally before covering it with a non-sticky dressing
If a hemangioma is causing problems, a doctor will prescribe propranolol, which is a beta-blocker that doctors often prescribe to treat heart conditions. Studies show that it can reduce the size of a hemangioma. It is a first-line treatment for infantile hemangiomas.
However, a doctor will only prescribe this drug when necessary because it can have adverse effects on heart rate and blood pressure. A doctor will monitor any child who is taking this drug.
However, not everyone can use propranolol. For example, it is not suitable for children with asthma.
If a child cannot use propranolol, a doctor may prescribe oral or topical corticosteroids to shrink the blood vessels. However, these too can have adverse effects.
If an ulcer forms, a doctor may prescribe antibiotics.
If necessary, a doctor will recommend surgery to prevent a hemangioma from causing damage to surrounding tissue, for example, if it is large or near the eye. The surgeon will cut out the tumor and close the wound using stitches.
However, complications include bleeding and the possibility that the hemangioma will come back.
In most cases, the mark goes away on its own in time.