Overview

Infantile hemangiomas, sometimes called "strawberry mark," is a common type of birthmark made of extra blood vessels that group together. These typically appear on the skin within the first few weeks or months after birth. The exact cause isn't fully understood, but it involves an overgrowth of the cells that line blood vessels.

Infantile hemangiomas are most common in babies, particularly premature infants, those with low birth weight, females, and Caucasian babies. It's important to know that hemangiomas are not contagious. While most are harmless and go away on their own, their appearance can sometimes cause worry for parents, and depending on their location or size, they might occasionally affect vision, breathing, or feeding.

Symptoms

You might notice the following signs if your child has an infantile hemangioma:

• A bright red, raised mark - on the skin, often with a bumpy texture, which is sometimes called a "strawberry hemangioma."
• A bluish or skin-colored swelling - deeper under the skin.
• It may start as a small, flat red spot, a pale area, or tiny visible blood vessels before growing.
• Rapid growth during the first few months of life (usually up to 3-6 months, sometimes longer).
• Most hemangiomas are painless, but they can occasionally become sore, especially if they break open (ulcerate).
• Some hemangiomas may feel slightly warm to the touch due to the increased blood flow.
• Their size can range from very small (like a pinhead) to quite large, covering a significant area of skin.

Diagnosis

Diagnosing an infantile hemangioma is usually straightforward for a healthcare professional.

• Most often, a doctor can diagnose a hemangioma simply by looking at its appearance and asking about its history (when it appeared and how it has changed).
• In rare cases, especially for deeper hemangiomas or if there's uncertainty, an ultrasound or MRI might be used to see the extent of the hemangioma and rule out other conditions.

Management & Treatment

Seeing a growth on your baby can be unsettling, but please be reassured that most hemangiomas are harmless and often don't require any treatment at all. Many fade away on their own over several years in a process called "involution."

The most common approach is often called "active observation" or "watchful waiting." This means your doctor will regularly check the hemangioma to make sure it's shrinking as expected and not causing any problems. However, treatment may be recommended if a hemangioma:

• Is in a high-risk location (e.g., near the eyes, nose, or mouth) where it could interfere with vision, breathing, or feeding.
• Is very large.
• Has developed a painful sore (ulceration) or is bleeding.
• Is causing significant distress for you or your child.

Available treatment options include:

• Topical Beta-Blockers: For small, thin hemangiomas, a medicated gel (like Timolol) can be applied directly to the skin. This can help stop the growth and reduce the redness.
• Oral Medications: The most common and effective treatment for problematic hemangiomas is an oral medication called Propranolol. This is an FDA-approved beta-blocker that is taken as a liquid. It works by narrowing the blood vessels, which shrinks the hemangioma. Treatment with propranolol is started and carefully monitored by a doctor.
• Other Treatments: In some situations, laser treatments or injections of corticosteroid medication directly into the hemangioma may be considered, especially to help with healing sores or treating what's left of the mark after it shrinks.

It's natural to want to do what's best for your baby. The right approach depends on the hemangioma's specific features. With treatment, you can often see improvement within a few weeks, though the full course of medicine may last for several months.

Important Safety Note: Never use any medication for a hemangioma without the guidance of a healthcare professional. If you are ever concerned about the hemangioma, especially if it starts to bleed or looks infected, contact your child's doctor right away.

Duration & Outlook

The timeline for an infantile hemangioma typically follows three phases:

1. Growth Phase (Proliferation): This usually occurs during the first 3-6 months of life (sometimes up to 12 months), where the hemangioma grows most rapidly.
2. Resting Phase (Plateau): The hemangioma stops growing and remains stable in size for a period.
3. Shrinking Phase (Involution): The hemangioma slowly begins to shrink and fade. This process can take several years. Many fade significantly by age 5, and most by age 10.

Infantile hemangiomas are considered an acute condition in terms of their growth phase, but their resolution is a long-term process. Most hemangiomas disappear without any issues. However, some may leave behind a slight change in skin color, texture, or a small area of loose skin. Warning signs for complications include rapid growth in sensitive areas (like near the eyes, nose, or mouth), bleeding, or signs of infection (pus, increased redness, warmth, pain) if the skin breaks open.

Prevention

Currently, there is no known way to prevent infantile hemangiomas. They are not caused by anything a mother did or did not do during pregnancy or delivery.

Causes & Triggers

The exact cause of infantile hemangiomas is not fully understood. They occur when endothelial cells, which line blood vessels, multiply more than they should. It's thought that certain proteins or factors during early development, possibly from the placenta, might play a role.

There are no known "triggers" that cause a hemangioma to appear or grow in the same way that certain foods might trigger an allergy. The growth is part of its natural lifecycle.

Who is most likely to develop it?

• Female infants
• Premature babies
• Babies with low birth weight
• Caucasian infants
• Babies born to mothers who had certain placental abnormalities or underwent chorionic villus sampling.
• Having a family history of hemangiomas may slightly increase the risk.

When to see a doctor

It's always a good idea to have any new or growing mark on your baby's skin checked by a doctor to confirm the diagnosis. You should definitely see a doctor or a dermatologist if:

• The hemangioma is located near your child's eyes, nose, mouth, or diaper area, as these can sometimes interfere with function or are more prone to problems.
• It is growing very rapidly.
• There are multiple hemangiomas (five or more), as this might indicate a need to check for internal hemangiomas.
• The hemangioma bleeds, looks infected (red, swollen, pus), or develops a sore (ulcerates).
• You are worried about its appearance or how it might be affecting your child.
• The hemangioma is very large.

A dermatologist is a specialist in skin conditions and can provide expert advice on monitoring and managing hemangiomas.

Frequently Asked Questions (FAQs):

• Q: Is a hemangioma painful for my baby? Most hemangiomas are not painful. However, if the skin over the hemangioma breaks down (ulcerates), it can be sore.
• Q: Will it leave a scar? Many hemangiomas fade completely without leaving a trace. Some might leave a slight change in skin texture, color, or a small area of stretched skin, especially if they were large or ulcerated.
• Q: Are hemangiomas cancerous? No, infantile hemangiomas are benign (non-cancerous) growths of blood vessels. They do not turn into cancer.
• Q: Can my baby have more than one hemangioma? Yes, some babies develop multiple hemangiomas. If your baby has five or more, it's important to see a doctor, as they may want to check for internal hemangiomas.
• Q: Did I do something wrong during pregnancy to cause this? Absolutely not. Hemangiomas are not caused by anything you did or didn't do during pregnancy. We understand it can be concerning to see a mark on your baby, but please know it's not your fault.

Remember, while this information is here to help you understand more, it's not a substitute for professional medical advice. Always consult with a healthcare provider for any concerns about your child's health.

References

• UCSF Benioff Children's Hospitals. (n.d.). Infantile Hemangioma. Retrieved from https://www.ucsfbenioffchildrens.org/conditions/infantile-hemangioma
• Mayo Clinic. (2023, June 10). Hemangioma. Retrieved from https://www.mayoclinic.org/diseases-conditions/hemangioma/diagnosis-treatment/drc-20352339
• American Academy of Dermatology Association. (n.d.). Hemangiomas: Signs, Symptoms, and Treatment. Retrieved from https://www.aad.org/public/diseases/a-z/hemangioma-treatment