Kids Health Info

Haemangiomas of infancy

  • Haemangiomas are common birthmarks which are usually red or purple. They mostly occur on the head and neck areas and develop shortly after birth.

    One in 10 babies will develop a haemangioma and it is more common in girls. Some children can have more than one haemangioma. If you choose to have further children, the risk of them having a similar birthmark is not increased.

    Causes

    Haemangiomas are caused by an overgrowth of the cells that line blood vessels (arteries and veins). This over growth of cells forms lesions or birthmarks.

    Signs and symptoms

    Haemangiomas appear in the first weeks of life. They are often confused with a scratch or bruising related to birth trauma.

    They then become a flat red patch often with blood vessels you can see. If they are on the skin surface they can look like a strawberry. If they are deeper in the skin they look like a bluish lump. Sometimes they have both a surface and a deep part. Haemangiomas can also grow on the internal organs. These behave in the same way as those on the skin.

    Haemangiomas grow fast in the first few months then slow down in the second six months of life. Sometimes they keep growing after the child's first birthday. When they have stopped growing, they tend to stay the same size for a while then start to disappear. Some will go away completely while other will leave behind a soft fatty lump. It is variable how quickly they disappear. Some have nearly gone by 3 years, while a small number (less than 1 in 10) are still there up to 8 or 9 years old.

    Usually, haemangiomas do not cause any problems. Occasionally the skin surface can ulcerate (develop a sore). When this happens they can become painful and can bleed, particularly if knocked or infected. This is most common in haemangiomas in the nappy area.

    Very rarely, children with a large haemangioma may have other problems, including brain, eye and heart problems, but the vast majority of children do not have these problems.

    A separate type of haemangioma is now recognized. Congenital haemangiomas are fully formed at birth. Some stay the same size for many years and others go away over the first few months of life. Another, much rarer, type of birthmark called a vascular malformation is sometimes confused with haemangioma. These do not go away but grow with the child. They are true birthmarks that remain throughout life. 

    Treatment

    Most haemangiomas disappear by themselves and do not need any treatment. Sometimes a small biopsy of skin is taken to find out what type of haemangioma it is.

    Haemangiomas need treatment if:

    • They are pressing on important structures such as the eyes, nose, ears or windpipe
    • It is on your child's eyelid or if it is large and on your child's face. These haemangiomas need urgent treatment to prevent serious problems.
    • They become ulcerated and painful and do not heal
    • To prevent your child having problems with their appearance when they reach school age

    Treatment should be given when the benefits of treatment outweigh the risks involved. All treatments have side effects which your doctor will discuss with you.

    Cortisone

    Cortisone can be taken by mouth or injected directly into the haemangioma. If this does not work, other medicines such as Propanolol,Vincristine and Interferon may be used.

    Laser therapy

    Laser treatment can sometimes help treat a haemangioma, especially if used very early in life while the haemangioma is still flat. Laser is a high energy light source. The particular laser used, Candela V-beam pulsed dye laser, only targets blood vessels. (See fact sheet: Dermatological (skin) laser therapy).

    This means it destroys the blood vessels that make up the birthmark without injuring the skin over the top. An anaesthetic and many treatments may be needed. The possible side effects of laser include ulceration, scarring, infection and the complications of an anaesthetic.

    Surgery

    In a few cases, haemangiomas are removed by surgery during the first year of life. Usually surgery is delayed for several years until the haemangioma has shrunk a lot.

    When your child's haemangioma has mostly disappeared, there may still be some scarring, loose skin or fatty lumps. These might need surgery or laser.

    Care at home

    • Haemangiomas do not usually need any special care
    • If the haemangioma bleeds, put firm pressure on the area for 10 minutes, or until the bleeding stops. Tell your doctor.
    • If an ulcer develops it can be painful and your child may be unsettled or distressed. You should visit your doctor who may prescribe a local anaesthetic cream to help reduce the pain and/or antibiotic cream for infection. Once you have put the cream on the ulcer, you will need to cover the ulcer with a dressing. Haemangiomas that are ulcerated can be quite slow to heal.

    When to come back

    • If your child's haemangioma bleeds and you cannot stop the bleeding with pressure, contact your local doctor or go to the nearest emergency department.
    • See your local doctor, dermatologist or paediatrician if your child has an ulcer that is very painful.

    Key points to remember

    • Haemangiomas usually go away by themselves without any treatment. However, some types of haemangiomas will need treatment.
    • Haemangiomas grow before they go away. This growth can be alarming but it does stop.
    • Haemangiomas can cause problems either by pressing on body parts, or by affecting your child's self-esteem and social development.
    • Haemangiomas that are on, or very near the eye, should receive urgent medical attention to prevent blindness.

    For more information

     

    Developed by RCH departments of  Dermatology, Plastic Surgery, General Surgery, General Medicine. First published 2004. Updated November 2010.

Disclaimer
This is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easily understood. The Royal Children's Hospital accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in the handouts.