Infantile hemangiomas are the most common type of benign vascular tumor in children. Infantile hemangiomas form when immature cells that are meant to form blood vessels form a tumor instead. An infantile hemangioma may also be called a "strawberry mark."
These tumors are not usually seen at birth but appear when the infant is 3 to 6 weeks old. Most hemangiomas get bigger for about 5 months and then stop growing. The hemangiomas slowly fade away over the next several years, but a red mark or loose or wrinkled skin may remain. It is rare for an infantile hemangioma to come back after it has faded away.
Infantile hemangiomas may be on the skin, in the tissue below the skin, and/or in an organ. They are usually on the head and neck but can be anywhere on or in the body. Hemangiomas may appear as a single lesion, one or more lesions spread over a larger area of the body, or multiple lesions in more than one part of the body. Lesions that are spread over a larger area of the body or multiple lesions are more likely to cause problems.
Infantile hemangioma with minimal or arrested growth (IH-MAG) is a certain type of infantile hemangioma that is seen at birth and does not tend to get bigger. The lesion appears as light and dark areas of redness in the skin. The lesions are usually on the lower body but can be on the head and neck. Hemangiomas of this type go away over time without treatment.
Risk Factors
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get the disease; not having risk factors doesn’t mean that you will not get the disease. Talk with your child's doctor if you think your child may be at risk.
Infantile hemangiomas are more common in the following:
- Girls.
- White patients.
- Premature babies.
- Twins, triplets, or other multiple births.
- Babies of mothers who are older at the time of the pregnancy, have pre-eclampsia (high blood pressure during pregnancy), or who have problems with the placenta during pregnancy.
Other risk factors for infantile hemangiomas include the following:
- Having a family history of infantile hemangioma, usually in a mother, father, sister, or brother.
- Having certain syndromes.
- PHACE syndrome: A syndrome in which the hemangioma spreads across a large area of the body (usually the head or face, but can include the neck, chest, or arm). The hemangioma may be small in rare cases. Other health problems that affect the large blood vessels, heart, eyes, and/or brain may also occur.
- LUMBAR/PELVIS/SACRAL syndrome: A syndrome in which the hemangioma spreads across a large area of the lower back. Other health problems that affect the urinary system, genitals, rectum, anus, brain, spinal cord, and nerve function may also occur.
Having more than one hemangioma or an airway or ophthalmic hemangioma increases the risk of having other health problems.
- Multiple hemangiomas: Having more than five hemangiomas on the skin is a sign that there may be hemangiomas in an organ. The liver is affected most often. Heart, muscle, and thyroid gland problems can also occur.
- Airway hemangiomas: Hemangiomas in the airway usually occur along with a large, beard-shaped area of hemangioma on the face (from the ears, around the mouth, lower chin, and front of neck). It is important that airway hemangiomas are treated before the child has trouble breathing.
- Ophthalmic hemangiomas: Hemangiomas that involve the eye may cause vision problems or blindness. Infantile hemangiomas can occur in the conjunctiva (a membrane that lines the inner surface of the eyelid and covers the front part of the eye). These hemangiomas may be linked with other abnormal conditions of the eye. It is important that children with an ophthalmic hemangioma are examined by an ophthalmologist.
Signs and Symptoms
Infantile hemangiomas may cause any of the following signs and symptoms. Check with your child’s doctor if your child has any of the following:
- Skin lesions: An area of spidery veins or lightened or discolored skin may appear before the hemangioma does. Hemangiomas occur as firm, warm, bright red to crimson lesions on the skin or may look like a bruise. Lesions that form ulcers are also painful. Later, as the hemangiomas go away, they become softer and begin fading in the center before flattening and losing color.
- Lesions below the skin: Lesions that grow under the skin in the fat may appear blue or purple. If the lesions are deep enough under the skin surface, they may not be seen.
- Lesions in an organ: There may be no signs that hemangiomas have formed on an organ.
Although most infantile hemangiomas are nothing to worry about, if your child develops any lumps or red or blue marks on the skin check with your child's doctor. He or she can refer the child to a specialist if needed.
Diagnostic Tests
A physical exam and history are usually all that are needed to diagnose infantile hemangiomas. If there is something about the tumor that looks unusual, a biopsy may be done. If the hemangioma is deeper inside the body with no change to the skin, or the lesions are spread across a large area of the body, an ultrasound may be done. Infants with five or more hemangiomas on the skin should have an ultrasound of the liver done to check for a liver hemangioma. See childhood vascular tumors for a description of these tests and procedures.
If the hemangiomas are part of a syndrome, more tests may be done, such as an echocardiogram, MRI, magnetic resonance angiogram, and eye exam.
Treatment
Most hemangiomas fade and shrink without treatment. If the hemangioma is large or causing other health problems, treatment may include the following:
- Propranolol or other beta-blocker therapy.
- Steroid therapy, before beta-blocker therapy is begun or when beta-blockers cannot be used.
- Laser surgery. Pulsed dye laser surgery may be used for hemangiomas that have ulcers or have not completely gone away.
- Surgery for hemangiomas that have ulcers, cause vision problems, or have not completely gone away. Surgery may also be used for lesions on the face that do not respond to other treatment.
- Topical beta-blocker therapy for hemangiomas that are in one area of the skin.
- Combined therapy, such as propranolol and steroid therapy or propranolol and topical beta-blocker therapy.
- A clinical trial of propranolol.