Infantile Hemangiomas

Does your baby have red or deep brown patches on the face immediately after birth or a few weeks later? Do the marks grow in size rapidly? Well, what you notice may be infantile hemangiomas. These are benign (noncancerous) tumors of blood vessels called capillaries that typically appear in infants within the first weeks or months of life. Often referred to as "strawberry marks" due to their red, raised appearance, these are usually not dangerous and regress on their own over time. However, due to complications associated with infantile hemangiomas, they may require treatment, especially for a larger and unsightly appearance. In such cases, treatment options may include medications, laser therapy, or surgical removal.

Scroll down to learn more about infantile hemangioma. This informative blog includes everything you need to know to stay well-informed about the condition.

What is Infantile Hemangiomas?

Infantile hemangiomas, also known as hemangiomas of infancy, are benign (noncancerous) vascular tumors. They are considered to be some types of birthmarks in infants or babies. They are often made up of endothelial cells (the cells that line the blood vessels). Infantile hemangiomas result from the abnormal formation of blood vessels that multiply uncontrollably. Most hemangiomas appear at birth or within the first few weeks (mostly 2 to 3 weeks after birth). They can occur in any body area, but the head and neck are the most common. 

Roughly 4% to 5% of all infants get infantile hemangiomas, which are most common in girls, twin births, and preterm or low birth weight babies. Most hemangiomas grow large rapidly at first (proliferative phase) and then slowly shrink or go away (period of shrinkage or involution phase). But some leave a mark or loose skin. 

What Are the Types of Infantile Hemangiomas?

Depending on where they appear, infantile hemangiomas are of three types, namely: 

Superficial Hemangiomas

• These are also known as cutaneous hemangiomas, as they grow on the skin's surface.
• Since they appear like red bumps, they are also known as strawberry hemangiomas. 

Deep Hemangiomas 

• These are also known as subcutaneous hemangiomas since they grow under the skin into deeper layers. 
• They often protrude or bulge with a blue or purple tinge. 

Mixed Hemangiomas

• These are a combination of superficial and deep hemangiomas. 

What Causes Infantile Hemangiomas?

The exact cause of infantile hemangiomas is unknown. It is not due to any environmental factors or medication taken during pregnancy. However, it is believed to be related to the changing oxygen levels that happen while the baby is developing in the womb. Hemangiomas can run in families, though there is no genetic cause or link. 

Risk Factors

• Being a female baby
• Preterm or premature birth
• Low birth weight
• Being a twin or a triplet 

What Are the Symptoms of Infantile Hemangiomas?

When the baby is born, it may not exhibit any signs of hemangioma. They usually become noticeable by four weeks of age. They may appear as a tiny bump, a scratch, or a red or blue patch on the skin. The patch may be flat or bumpy, depending on where they develop. They often develop on the face, scalp, back, or chest. The infant may have one or more than one mark. 

During your child's first year, the mark may grow rapidly into a spongy, rubbery-looking bump that sticks out or bulges from the skin. The hemangioma then enters the rest phase and begins to go away slowly. 

What Are the Complications of Infantile Hemangiomas?

It is essential to identify a hemangioma and seek medical help. Else, it can lead to several complications, causing problems by:

• Blocking vision 
• Restricting eye movements
• Reducing airflow through the nose and mouth
• Excessive bleeding
• Breaking down the skin surface (ulceration)
• Excess bleeding can put a strain on the baby's heart 
• Affects the infant's appearance due to the presence of unaesthetic marks on the face 
• Causing anxiety and depression due to bullying by others because of the presence of an unaesthetic appearance 

How is Infantile Hemangiomas Diagnosed?

Doctors, preferably dermatologists (doctors specializing in diagnosing and treating conditions related to the skin, hair, and nails), can easily diagnose hemangiomas by the appearance of the bump. Conducting a physical exam and evaluating the medical history, such as the type of pregnancy and the baby's health, can help doctors reach a diagnosis. 

Further evaluation may be done through:

• Ultrasound scan 
• MRI (Magnetic Resonance Imaging)

When Does Infantile Hemangioma Need Treatment?

Treatment for infantile hemangiomas depends on the baby's age, location, and growth rate. 

Your baby may require treatment for infantile hemangiomas for three main reasons:

Medical Problems

• Large and rapidly growing hemangiomas may interfere with vital functions.
• Enlarged hemangiomas may make it challenging for the baby to see, hear, eat, or breathe well. 

Skin Breakdown

• There is an increased risk of skin breakdown and ulcer formation, which could lead to bleeding, infection, or scarring. 

Permanent Skin Changes 

• Even after the hemangioma goes away, it can leave permanent marks on the skin and impact its texture. 
• This can be of great concern if it occurs on the face and negatively impact the child's aesthetic appearance.  

How Can Infantile Hemangiomas Be Treated?

Depending on the child's age, location, and the growth of hemangiomas, your doctor can recommend any one of the following treatments: 

Localized Treatments

Topical Medications

• These are in the form of creams, lotions, and gels that are applied directly on the skin.
• Often helpful for small, superficial hemangiomas.
• Prescription topical medications containing beta blockers are the most effective option since they stop growth, shrink hemangiomas, and fade them.
• Your doctor may also prescribe steroid topical creams for smaller hemangiomas.

Steroid Injections

• Smaller, localized hemangiomas can be effectively treated through steroid injections administered directly into the bumps.
• The steroid helps shrink the hemangiomas and reduce inflammation.

Systemic Treatments

Beta Blockers 

• These medications have been used for centuries to manage high blood pressure levels. 
• These are commonly given orally and continued until the first year to avoid rebound growth. 

Oral Steroids 

• They must be given under the doctor's strict supervision, though they are not currently preferred. 

Other Treatments 

Surgery 

• Surgical intervention is preferred for small hemangiomas that cause problems or lead to skin breakdown.
• It is only recommended when the hemangiomas shrink or other ineffective treatment options.
• Since early surgery may leave a scar, it is usually delayed between 3 and 5 years of age. 

Laser Therapy

• Laser light of different wavelengths is targeted on the affected areas to stop bleeding or heal hemangiomas with open ulcers. 

Takeaway

Infantile hemangiomas are common during birth or a few weeks after the baby is born. They appear as red or brown flat patches, birthmarks, or raised bumps that may initially grow rapidly but gradually slow down, fading. Though the exact cause is unknown, it could have been caused by tangled blood vessels.  

Contact the doctor if you notice anything developing on your baby's skin. Most hemangiomas may fade away, but a few may cause complications. However, prompt evaluation, monitoring, and treatment can help ensure problematic hemangiomas have as little impact as possible on your child.