Hemangioma – Causes, Symptoms and Treatment
A hemangioma (also called a strawberry mark) is a benign vascular tumor commonly found in infants that usually resolves on its own over time.
Things worth knowing about "Hemangioma"
A hemangioma (also called a strawberry mark) is a benign vascular tumor commonly found in infants that usually resolves on its own over time.
What is a Hemangioma?
A hemangioma (also spelled haemangioma) is a benign (non-cancerous) overgrowth of blood vessels in the skin or internal organs. It is the most common vascular tumor in childhood. Hemangiomas typically appear as red, raised or flat marks on the skin and develop during the first weeks of a baby's life. They grow rapidly in the first months before gradually shrinking and fading on their own.
Types of Hemangiomas
Superficial Hemangioma
Located just below the surface of the skin, this type appears as a bright red, raised, and bumpy lesion -- often compared to a strawberry. It is therefore commonly referred to as a strawberry hemangioma or strawberry mark.
Deep Hemangioma
This type develops deeper in the skin tissue and appears as a soft, bluish-purple swelling beneath the skin surface. It is less common than the superficial type.
Mixed Hemangioma
A combination of superficial and deep components, displaying both the typical red surface and a bluish deeper portion.
Causes
The exact cause of hemangiomas is not yet fully understood. It is believed that a disruption in the regulation of blood vessel formation (angiogenesis) during early fetal development plays a key role. Risk factors include:
- Premature birth or low birth weight
- Female sex (girls are more commonly affected than boys)
- Fair skin
- Multiple pregnancies (twins, triplets)
- Advanced maternal age
Symptoms and Appearance
Hemangiomas are usually not visible at birth or may appear as a small pale spot. They begin to grow in the first weeks of life and typically reach their maximum size between 6 and 12 months of age. Characteristic features include:
- Bright red, raised skin lesion
- Soft, rubbery texture
- Well-defined borders
- Painless in uncomplicated cases
- Size ranges from a few millimeters to several centimeters
Course and Prognosis
Most hemangiomas resolve on their own without treatment through a process called spontaneous involution. Approximately 50% disappear by age 5, 70% by age 7, and 90% by age 9. After involution, a faint scar, pale patch, or slightly loose skin may occasionally remain.
Complications
In rare cases, hemangiomas can cause problems, especially when they:
- Grow near the eyes, mouth, nose, or airways and affect normal function
- Ulcerate (break open) and bleed or become infected
- Occur in visible areas such as the face and cause cosmetic concerns
- Affect internal organs (e.g., the liver) and cause related symptoms
Diagnosis
Diagnosis of a hemangioma is usually made through a clinical examination by a pediatrician or dermatologist. The typical appearance and natural course are usually sufficient for diagnosis. In unclear cases or when deep or internal hemangiomas are suspected, imaging may be used:
- Ultrasound: Assesses the depth and blood flow within the hemangioma
- MRI (Magnetic Resonance Imaging): Provides detailed imaging for deep or organ-adjacent hemangiomas
Treatment
Since most hemangiomas resolve spontaneously, treatment is often not required in uncomplicated cases. Therapy is recommended when the hemangioma impairs function, ulcerates, or causes significant cosmetic distress.
Medication
The first-line treatment today is propranolol, a beta-blocker that inhibits the growth of hemangiomas and accelerates their regression. It is given orally and is generally well tolerated. For smaller, superficial hemangiomas, a topical formulation containing the active ingredient timolol is also available.
Laser Therapy
A pulsed dye laser may be used to treat superficial hemangiomas, particularly to address residual blood vessels or discoloration that remain after involution.
Surgical Removal
In rare cases, such as severely disfiguring or function-impairing hemangiomas, surgical removal may be considered.
When to See a Doctor
Parents should seek medical advice if:
- The hemangioma grows rapidly or begins to bleed
- It is located near the eyes, mouth, or airways
- It ulcerates or shows signs of infection
- More than three hemangiomas are visible on the skin (possible internal involvement)
References
- Hoeger PH et al. - Management of infantile haemangiomas: practice guidelines of the European Society for Paediatric Dermatology. Journal of the European Academy of Dermatology and Venereology, 2020.
- Leaute-Labreze C et al. - Propranolol for Severe Hemangiomas of Infancy. New England Journal of Medicine, 2008; 358(24): 2649-2651.
- American Academy of Dermatology (AAD) - Hemangioma: Diagnosis and Treatment. Available at: www.aad.org, 2023.
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