HEMANGIOMAS: WHAT ARE THEY?

Hemangiomas are simply a collection of extra blood vessels in the skin. They may have different appearances depending on the depth of the increased numbers of blood vessels.

 
Fig. A

• Strawberry Hemangioma is an abnormal collection of blood vessels in the skin characterized by a bright red color and well-defined border.
   
• A Deep or Cavernous Hemangioma is a large, collection of blood vessels beneath the skin surface characterized by a soft, bluish, or skin colored mass.
   
• A Combined Hemangioma is a combination of a deep and superficial (strawberry) hemangioma.

Hemangioma in one-year-old baby

HEMANGIOMAS: HOW COMMON ARE THEY?

Hemangiomas are one of the most common birthmarks in newborns. Most hemangiomas are not present at birth but develop within the first few weeks to months of life. They are found in up to 10 percent of babies by the age of one.

HEMANGIOMAS: WHY DO THEY OCCUR?

The cause of hemangiomas is unknown. In very rare instances they may run in families, but in general they are not inherited. For a parent with a child with this birthmark, there is no increased risk of having a subsequent child with a hemangioma. Hemangiomas are more common in girl babies than boys. They are also more commonly seen in premature infants.

TYPICAL GROWTH PATTERN OF HEMANGIOMAS: WHEN WILL THEY GO AWAY?

Age of Child	Hemangiomas
Birth	often not present or noticeable
1-2 months	becomes noticeable
1-6 months	grows most rapidly
12-18 months	begins to shrink (involute)

Hemangiomas usually involute (shrink away) in time. 30% of hemangiomas will resolve by 3 years of age 50% by 5 years of age, and 80%-90% by 9 years of age. Over one-half of hemangiomas heal with an excellent cosmetic result without treatment.

WHICH HEMANGIOMAS NEED TREATMENT?

Hemangiomas usually appear, grow and go away without problems. In most cases, we do not recommend treatment. Some hemangiomas can cause significant problems, however. Scenarios that may be more complicated and require treatment include:

1) Involvement of a vital organ, like the eye or ear, or windpipe
2) Bleeding
3) Ulceration
4) Crusting or infection
5) Rapid growth and deformity of the surrounding tissues

Hemangiomas in certain areas may have a higher risk of complications. These areas include the face (especially nose and lips), body folds, and groin. Hemangiomas in certain locations, which affect function, or are complicated by infection or ulceration, may be treated with laser, medication, or injections. If any worrisome signs appear such as these listed above, please contact your physician.

Hemangioma Under the Eye Before Pulsed Dye Laser Treatment and Cortisone	Hemangioma Under the Eye After Pulsed Dye Laser Treatment and Cortisone

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Fig. Baby born with hemangioma on scalp before treatment. Notice the open sores which have developed within the birthmark leading to pain and discomfort for the baby.	Fig. Same baby after multiple laser treatments and injections of cortisone into the birthmark.

WHAT TREATMENTS ARE AVAILABLE?

In many instances no treatment will be indicated. If treatment is needed, however, it may include:

Cortisone: Injected into the hemangioma or given orally by mouth. If given orally for prolonged periods has side effects including increased risk of systemic infection, high blood pressure, diabetes, increased appetite, stomach irritation, growth suppression, etc.

Pulsed Dye Laser Therapy: This therapy treats the superficial blood vessels best. If this treatment is recommended it is usually reserved for the superficial component of hemangioma, characterized by a flat, red lesion. It is usually administered in a series of laser treatments spaced 2-4 weeks apart.

Antibiotics: If the hemangioma is infected and open it may be treated with a short course of antibiotics and daily wound cleansing.

Alpha Interferon: This therapy is limited to the most severe and potentially life threatening hemangiomas. It involves administering systemic medication via daily shots, usually into the leg, for several months. It is usually given to the baby by the parents under physician direction and supervision. This therapy has serious potential side effects including neurologic effects, blood abnormalities and others.

Surgical removal: In rare instances, hemangiomas may be surgically removed especially if they are not likely to resolve spontaneously or lead to significant tissue distortion and deformation.

 

Children, adolescents and adults must be referred to one of the multidisciplinary team members who may then refer the patient to the Vascular Lesion Clinic. Questions may be directed to Therese Cosan, RN, Vascular Lesion Clinic Administrator at (858) 576-1700 ext-6841.

Vascular Lesion Clinic
8010 Frost Street, Suite 602
San Diego, CA 92123
Phone: (858) 576-1700 ext-6841

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