RCH logo

Primary Care Liaison

Haemangioma – infantile

  • *STATEWIDE REFERRAL CRITERIA have been published for this condition. For more information, please see the Department of Health website www.health.vic.gov.au/statewide-refrral-criteria*

    Introduction

    This guideline relates to haemangiomas in paediatric patients. Most infantile haemangiomas do not require treatment. Haemangiomas that may require investigations and/or treatment include:

     

    Type of Haemangioma Potential Associated Problems
    Large head or neck Brain abnormalities, eye abnormalities, stroke, congenital heart disease, airway haemangioma, permanent deformity
    Eyelid/peri-orbital Permanent visual deficit
    Nose/lip Permanent scaring or deformity, feeding difficulties
    Face/neck/upper chest Cosmetic issues, permanent residual changes at site, scarring, atrophy, telangiectasia and redundant skin
    Large haemangioma on lower back or anogenital area Urogenital and spine abnormalities
    Large haemangioma involving nipple area in females Significant cosmetic sequelae in both childhood and adulthood
    Napkin area haemangioma Painful ulceration that is difficult to heal
    Five or more haemangiomas Large liver haemangioma with resulting cardiac failure and possible hypothyroidism. If child is unwell or under three months of age, liver ultrasound is warranted

    When to refer

    • Patients <16 years of age

    Referral criteria/required information

    Birthmarks | health.vic.gov.au

    How to refer

    RCH Specialist Clinics Referral.pdf

    Please complete the above and submit via:

    Suggested pre-referral work-up/management 

    • Most children do not require treatment for their haemangioma
    • For small, flat haemangiomas on the face
      • Topical Timolol Maleate 0.5% gel forming drops, one drop applied to the haemangioma with a finger twice a day is reasonable
      • If this successfully prevents further growth, and gives early fading, it can usually be ceased after 4-6 months treatment
      • Topical Timolol is less effective than oral beta blocker and is not adequate for larger troublesome haemangiomas
    • For haemangiomas requiring treatment (e.g., red flags above), treatment should be started early to reduce the possibility and severity of complications. Consider urgent referral
    • If oral beta blocker (atenolol or propranolol) is commenced locally by a doctor with experience in this area, detailed guidelines have been published
    • Liver ultrasound if there are five or more haemangiomas in infant under 3 months of age
    • Consider differentials; vascular malformations (e.g., port wine stain malformation, venous malformation, lymphatic malformation), pyogenic granuloma, tufted angioma, sarcoma, myofibroma, neuroblastoma, leukaemia cutis
      • Refer for urgent paediatric dermatology specialist opinion if uncertain diagnosis or atypical history or atypical clinical features for infantile haemangioma

    Information for families

    Resources and links

    Acknowledgements

    The development of this guideline was coordinated by the Department of Dermatology, Plastic and Maxillofacial Surgery, General Medicine and the Education Hub at The Royal Children’s Hospital. Guideline reviewed in August 2025.