What Is a Hemangioma?

A hemangioma is a benign (non-cancerous) growth of blood vessels that appears at birth or within the first few weeks after birth. Hemangiomas are the most common benign vascular lesion in babies, affecting 4% to 5% of newborns. Hemangiomas are often called strawberry birthmarks because of their red, rubbery, bumpy appearance.

Sometimes small benign vascular lesions in adults are called hemangiomas, or cherry hemangiomas, but most discussions of hemangiomas involve infant hemangiomas.

Experts aren’t sure what causes hemangiomas, but they originate from blood vessels that don’t form normally. Hemangiomas rarely cause complications, and most of them go away on their own by the time a child is 9 years old, and often earlier. When hemangiomas do cause complications, they can grow too large; become infected; or affect breathing, feeding, or sight. Treatment options may include medication to shrink the hemangioma, topical ointments, laser treatment, or surgery.

Types of Hemangiomas

There are two main types of hemangiomas: infantile hemangiomas and congenital hemangiomas. Infantile hemangiomas form within the first few weeks and months after birth. Congenital hemangiomas are present at birth. The majority of hemangiomas are infantile hemangiomas.

Infantile Hemangiomas

Infantile hemangiomas aren’t present at birth but form within the first weeks or months of an infant’s life. Typically, the lesions grow rapidly for a period of time and then begin a period of shrinking (involution). Most hemangiomas are seen on the surface of the skin. Some hemangiomas are deeper, forming below the surface of the skin. Others are a combination of superficial and deep.

Congenital Hemangiomas

Congenital hemangiomas are present at birth. There are two subtypes of congenital hemangiomas: involuting and non-involuting hemangiomas. Involuting congenital hemangiomas shrink and resolve within the first eight to 14 months after birth. Non-involuting congenital hemangiomas don’t shrink and instead grow as the child grows. Non-involuting congenital hemangiomas may require surgical removal.

Hemangioma Symptoms

Infantile hemangiomas, the most common type, usually appear within one to four weeks after birth. Most of the time, babies only have one hemangioma, but some have multiple. Hemangiomas are found on the head or neck 60% of the time. Meanwhile, 25% of hemangiomas appear on the trunk of the body, and 15% are on the arms and legs.

Hemangiomas look like reddish, purplish, raised, bumpy lesions on the skin. Superficial hemangiomas are often bright red and resemble a strawberry, which is why they are sometimes referred to as strawberry birthmarks. Deeper hemangiomas may look more bluish and appear swollen.

Superficial hemangiomas grow quickly during the first three months of life, then begin to slow in growth by five to eight months. Deep hemangiomas grow longer, up until nine or 12 months, before they begin to slow in growth.

What Causes Hemangiomas?

The exact cause of hemangiomas is unknown, but they appear when blood vessels don’t form in a typical way. Specifically, the lesions result from abnormally high rates of division and growth among vascular endothelial cells.

Risk Factors

While the precise causes of hemangiomas are unknown, there are certain factors that might increase the risk of developing them. Your infant might be at an increased risk for a hemangioma if they:

• Are female
• Are white
• Were born prematurely
• Weigh less than 2.2 pounds
• Have a family history of hemangioma

Pregnancy factors that can increase an infant's risk of developing a hemangioma include having:

• Multiples (carrying more than one child at a time)
• Placenta previa (when the placenta covers the cervix)
• Preeclampsia (high blood pressure during pregnancy)
• A baby when you are older
  

How Are Hemangiomas Diagnosed?

Parents usually notice a hemangioma within a few weeks after their baby is born and may take their baby to the pediatrician wondering what the mark is. Most of the time, a healthcare provider can diagnose a hemangioma just by looking at it, as they are common in newborns and have a characteristic look. Usually, no further tests are required after a clinical diagnosis.

If a provider is unsure what type of lesion is present, they may order a skin biopsy. This is when a small sample of the lesion is removed and examined to determine what it is. If a hemangioma is deep or if a provider suspects there may be hemangiomas in organs inside the body, imaging tests might be utilized.

Imagining tests for hemangiomas include:

• Ultrasound, which uses sound waves to produce images of organs inside the body
• Computer tomography (CT), which is a type of detailed X-ray that takes cross-sectional images of the body
• Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to produce images of tissues and organs in the body
  

Treatments for Hemangiomas 

In the vast majority of cases, treatment for hemangiomas is not necessary. After a period of intense growth, growth slows. The lesion then begins to recede, and within a few years hemangiomas disappear.

Hemangiomas need treatment when they are very large, become infected, or interfere with other bodily functions.

The following treatment may be used to manage hemangiomas that cause complications:

• Propranolol: Sold under brand names like Inderal XL and Hemangeol, the beta blocker can help slow the growth of fast-growing hemangiomas.
• Oral steroids: Can slow hemangioma growth
• Topical (skin) medications: Can help with infected hemangiomas
• Surgery: Can be performed to remove hemangiomas (only in rare cases since hemangiomas are expected to shrink on their own in time)
• Laser treatment: Usually done after hemangiomas have gone away to fix any remaining issues on the skin
  

How to Prevent Hemangiomas

As of now, there are no known ways to prevent hemangiomas. Although limited research has found there may be increased risk of hemangiomas in babies born prematurely or to parents with conditions like placenta previa, these are factors largely out of a person’s control. Moreover, there is no evidence that controlling these factors will prevent hemangiomas from occurring.

Complications

Hemangiomas located close to a child's lips and mouth may pose problems with feeding. Hemangiomas located near the eyes can cause trouble with sight. Hemangiomas located near the nose, mouth, or throat may cause problems with breathing. The larger the hemangioma, the more likely it is to cause issues.

When a child has multiple hemangiomas, it’s possible they may also have hemangiomas growing inside their body. This can be determined with imaging tests. Hemangiomas located in the liver can cause heart issues or hypothyroidism (when the thyroid gland doesn't make enough thyroid hormone).

Ulceration is one of the most common complications with hemangiomas. This is when the hemangioma becomes infected, has an open sore, or bleeds. Ulcerated hemangiomas can cause scarring of the skin.

Living With a Hemangioma

The vast majority of hemangiomas resolve and do not have complications. Uncomplicated hemangiomas usually peak in growth by the time a baby is 5 months old and then begin to slow down, eventually going away.

In about half of all cases, hemangiomas are gone by the time a child is 5 years old. Then, 70% of hemangiomas resolve by the time a child is 7, and 90% disappear by age 9. In about 8% of cases, there are skin differences that may need treatment for full resolution.

Even in more complicated cases of hemangiomas, there are many options available, including treatment to reduce the size of the hemangioma and treatments to reduce the appearance of scarring or other skin changes.