Hemangioma

(Infantile Hemangioma; Superficial Hemangioma; Deep [or Cavernous] Hemangioma; Strawberry Hemangioma; Strawberry Mark)

Definition

A hemangioma is a type of birthmark. It develops shortly after birth, usually on the head or neck. It may be close to the surface of the skin or deeper below the skin.For most, a hemangioma will grow quickly and then slowly disappear over time. It is often gone before puberty. If your child develops a birthmark that grows, talk to a doctor.

Causes

A hemangioma is a cluster of blood vessels that do not form normally. It is not known what cause hemangiomas. It is also unclear on what makes them grow, or disappear.

Risk Factors

Hemangiomas are more common in Caucasian baby girls. Other factors that may increase a baby's chance of a hemangioma include:
  • Premature birth
  • PHACE syndrome

Symptoms

Symptoms will depend on the location of the hemangioma:
  • A hemangioma that is close to the surface of the skin:
    • Appears as red strawberry-like or purple bump on the skin
    • May continue to grow and spread
  • A hemangioma that is deeper under the skin will appear as bluish swelling under the skin
Most hemangiomas have no further symptoms. However, some large hemangiomas may lead to:
  • Ulceration—deep sores in the skin
  • Scarring
  • Disfigurement
  • Problems with growth and function of structures nearby such as eyes or airway
  • Abnormalities of the blood vessels of the eye or brain (associated with some hemangiomas of the face)
  • Hemangiomas in other locations can be associated with heart, kidney, gastrointestinal, brain, or spinal abnormalities

Diagnosis

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Some hemangiomas are obvious with physical exam. If there is any question, your doctor may recommend testing. Tests may also be done to determine the size and effect on local organs.Imaging tests can evaluate the hemangioma and surrounding structures. These may include:

Treatment

Most hemangiomas will resolve on their own. The mark will significantly fade by age 5 and nearly disappear by puberty. Your doctor may only recommend monitoring during the growth period.If the hemangioma is causing problems your doctor may recommend one or more of the following treatments:
  • Dressings to help prevent infections in ulcerated areas of the skin and control oozing
  • Medication may include:
    • Acetaminophen for pain relief
    • Steroids, vincristine, or beta blockers to help shrink the hemangioma
    • Topical ointments to help with wound healing and pain relief
    • Antibiotics may speed healing with or without the presence of a bacterial infection
  • Surgery—particularly for hemangiomas that are causing pain, or problems with sight or breathing
  • Lasers—most effective on superficial hemangiomas
If ulcers have developed more aggressive treatment may be needed. It may require a combination of treatments above.

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Prevention

There are no current guidelines to prevent hemangiomas because their cause is unknown.

RESOURCES

American Academy of Dermatology
http://www.aad.org

Vascular Birthmarks Foundation
http://www.birthmark.org

CANADIAN RESOURCES

Health Canada
http://www.hc-sc.gc.ca

Sturge-Weber Syndrome Community Canada (SWSCC)
http://swscommunitycanada.org

References

Bruckner AL, Frieden IJ. Hemangiomas of infancy. J Am Acad Dermatol. 2003;48:477-493.

Burton BK, Schulz CJ, et al. An increased incidence of haemangiomas in infants born following chorionic villus sampling (CVS). Prenat Diagn. 1995;15:209-214.

Haggstrom AN, Frieden, IJ. Hemangiomas: Past, present, and future. J Am Acad Dermatol. 2004;51: S50-52.

Hemangioma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 13, 2013. Accessed February 10, 2014.

Luu M, Frieden IJ. Haemangioma: clinical course, complications and management.Br J Dermatol. 2013;169(1):20-30.

10/25/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Haggstrom AN, Garzon MC, Baselga E, et al. Risk for PHACE syndrome in infants with large facial hemangiomas. Pediatrics. 2010;126(2):e418-e426.

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