Haemangiomas are common birthmarks found in infants. Learn more about what causes these vascular birthmarks, treatment options, and when to seek medical advice for your baby.
Introduction: What Are Infantile Haemangiomas?
Discovering a birthmark on your baby's skin can be alarming for parents, but the majority of infantile haemangiomas are harmless. Affecting up to 10% of infants, haemangiomas are benign (non-cancerous) growths made up of blood vessels. These typically appear during the first few weeks of life and often resolve on their own over time. While they commonly appear on the head and neck, haemangiomas can form anywhere on the body. In most cases, no treatment is needed, but medical intervention may be required if complications arise.
What Causes Haemangiomas in Babies?
The exact cause of infantile haemangiomas is still unclear, but certain factors can increase a baby's likelihood of developing them. These risk factors include:
- Premature birth and low birth weight
- Multiple pregnancies (e.g., twins or triplets)
- Female gender
- Family history of haemangiomas
While no specific gene has been directly linked to haemangiomas, research indicates that irregularities in blood vessel development during pregnancy could contribute to their formation. However, further studies are needed to fully understand their cause.
Types of Infantile Haemangiomas
There are three main types of haemangiomas, each differing in appearance and depth:
- Superficial Haemangiomas (Strawberry Naevus): The most common type, these begin as bright red, flat patches that later become raised, resembling a strawberry, hence the nickname "strawberry birthmark".
- Deep Haemangiomas: These grow beneath the skin, often giving a bluish or skin-coloured appearance. They typically present as smooth, swollen areas that may not be noticeable initially.
- Mixed Haemangiomas: A combination of both superficial and deep haemangiomas, these appear red on the surface, with bluish or skin-coloured swelling underneath.
Growth and Development of Haemangiomas: What to Expect
Haemangiomas usually become noticeable within the first few weeks of a baby’s life. During the first 3 to 6 months, they often grow rapidly, which can be concerning for parents. However, this growth phase typically slows down and stops by the time the child reaches around 12 months of age, with very few cases continuing to grow beyond that point.
Once the haemangioma stops growing, it gradually begins to shrink and fade. While many haemangiomas will disappear completely over time, some may leave behind loose skin or slight discoloration. By the time your child reaches 5 years old, the haemangioma will usually be much flatter and lighter. In most cases, it will be barely visible or completely gone by the age of 10.
Though haemangiomas are typically harmless, treatment may be necessary if they affect critical areas or cause complications.
As a general rule, approximately 50% of haemangiomas resolve by age 5, 70% by age 7, and 90% by age 9.
Signs and Symptoms of Haemangiomas
Haemangiomas can vary in appearance depending on their type and location. Superficial haemangiomas typically start as small red patches, while deeper haemangiomas may appear as bluish or skin-coloured swellings. While haemangiomas most often occur on the skin, they can also develop internally, such as in the liver. Internal haemangiomas are usually discovered by chance and are generally harmless, though in rare cases, they may cause complications by affecting vital organs.
When multiple skin haemangiomas are present, it can raise concerns about the possibility of internal haemangiomas, which may require further investigation.
Haemangiomas usually don't cause pain or other symptoms. However, in some cases, they can become problematic, especially if they ulcerate, bleed, or grow in sensitive areas, which may lead to discomfort or other complications (see below).
Diagnosis: How Are Haemangiomas Identified?
Haemangiomas are typically diagnosed through a physical examination. If the diagnosis is unclear, or if the haemangioma is in a location that might affect a child's normal development, imaging tests such as an ultrasound or MRI may be recommended. Early diagnosis helps in deciding the best treatment plan, especially if the haemangioma poses any health risks.
Are Haemangiomas Dangerous?
Most haemangiomas are not harmful and do not require treatment. However, they can pose risks if located near sensitive areas such as the eyes, nose, or mouth, where they may interfere with breathing, feeding, or vision. Larger haemangiomas may also ulcerate, bleed, or cause scarring, necessitating medical evaluation.
When to Seek Medical Advice
Parents should consult a paediatrician or dermatologist if the haemangioma:
- Causes discomfort or pain
- Is growing rapidly
- Bleeds or ulcerates
- Interferes with essential functions such as eating or breathing
- Affects the eyes or vision
- Impacts your child’s self-esteem or social development
Treatment Options for Infantile Haemangiomas
Most haemangiomas resolve on their own and do not require treatment. However, intervention may be necessary if the haemangioma:
- Presses on critical structures such as the eyes, nose, ears, or windpipe.
- Is located on your child’s eyelid or is large and situated on their face, necessitating urgent treatment to prevent serious complications, including blindness.
- Bleeds, becomes ulcerated, is painful, or does not heal.
- Affects your child’s self-esteem and social development, particularly as they approach school age.
Treatment should only be provided when the benefits outweigh the associated risks. All treatments may have side effects, which your doctor will discuss with you.
Here are the treatment options:
- Observation: Most haemangiomas do not require treatment and are simply monitored over time.
- Medications:
- Beta Blockers (Propranolol or Atenolol) are typically the first-line treatment. They help restrict blood flow, prevent further growth, and shrink haemangiomas. These medications may require monitoring of heart rate, blood pressure, and blood sugar levels when the child is unwell.
- Corticosteroids are alternatives for babies who cannot take beta blockers. They are effective in preventing haemangioma growth during the early growth phase (2-4 months of age) but do not contribute to shrinking the haemangioma.
- Topical Treatments: Small haemangiomas can be treated with topical beta blockers like Timolol or Propranolol.
- Laser Therapy: Laser treatment can reduce the appearance of early haemangiomas and help improve skin texture after they shrink.
- Surgery: Surgery is rarely performed during infancy but may be considered for large haemangiomas after they have shrunk to remove excess skin or manage scarring.
Home Care Tips for Parents
If your baby has a haemangioma, focus on keeping the area clean and protected, especially if it is in a location prone to friction or injury. If ulceration occurs, follow your doctor’s advice for wound care to prevent infection or bleeding.
Conclusion: Understanding and Managing Haemangiomas in Babies
Infantile haemangiomas are common, benign growths that often resolve on their own. However, parents should remain vigilant during the early growth phase and seek medical advice if complications arise, particularly when haemangiomas affect vital functions like vision, breathing, or feeding.
Most haemangiomas shrink over time, but in certain cases, treatments such as beta blockers, corticosteroids, laser therapy, or surgery may be necessary. It's also important to consider the potential emotional impact, especially as children grow older.
Ultimately, the decision to treat should be made with healthcare professionals, balancing risks and benefits. Regular monitoring and open communication with your paediatrician or dermatologist will ensure your child receives the best care and support.
Frequently Asked Questions (FAQs) About Haemangiomas in Babies
Are there other birthmarks that look like infantile haemangiomas?
Yes, there are other birthmarks that can resemble infantile haemangiomas. One type is congenital haemangiomas, which are fully formed at birth and do not grow further. Some congenital haemangiomas remain the same size for years, while others resolve within the first few months of life. Unlike infantile haemangiomas, there are no medications available to shrink congenital haemangiomas, and treatment typically involves careful observation. In more complicated cases, surgery or laser treatment may be required.
Another condition that may be confused with a haemangioma is a vascular malformation. Unlike haemangiomas, vascular malformations are permanent birthmarks that do not shrink and grow along with the child, persisting throughout life.
Can haemangiomas be prevented?
No, haemangiomas cannot be prevented. Their development is linked to factors that are not yet fully understood, making it impossible to prevent them at this time.
Do haemangiomas cause pain?
Most haemangiomas are painless. However, if they ulcerate (form sores), they can cause discomfort or pain.
Will a haemangioma leave a scar?
In many cases, haemangiomas resolve without leaving scars. However, larger haemangiomas or those that ulcerate may leave scars or areas of discoloration.
Can haemangiomas affect a baby’s development?
In rare cases, haemangiomas located near the eyes, nose, or mouth can interfere with development and require early treatment to prevent complications.
How long do haemangiomas last?
Most haemangiomas grow during the first year of life and begin to shrink afterward. The most rapid shrinking occurs between ages 1 and 4. Approximately 50% of haemangiomas will resolve by age 5, 70% by age 7, and 90% by age 9.
What are the potential side effects of haemangioma treatments?
Oral medications such as propranolol and atenolol used to treat haemangiomas can affect blood pressure and heart rate. They may also reduce your baby’s ability to respond to low blood sugar during illness, so close monitoring of blood sugar levels is essential. Regular assessments by your child's doctor are necessary while on these medications.
For surgical or laser treatments, the risks include scarring and side effects related to anaesthesia or sedation, so it's important to discuss these risks with your child’s doctor.
What should I do if the haemangioma bleeds?
If the haemangioma begins to bleed, apply firm pressure to the area for 10 minutes or until the bleeding stops. It’s important to inform your doctor about the incident. If the bleeding does not stop, seek immediate assistance at your nearest emergency department.
When should I start treatment for my baby’s haemangioma?
Treatment for haemangiomas is usually not urgent unless the haemangioma is rapidly growing, located in a sensitive area, or causing complications such as ulceration or bleeding. If treatment is needed, it is typically most effective during the early growth phase (before the baby is 4 to 6 months old).
What is the difference between infantile and congenital haemangiomas?
Infantile haemangiomas typically appear in the first few weeks of life and grow rapidly before shrinking over time. In contrast, congenital haemangiomas are fully formed at birth and do not grow further. Some congenital haemangiomas may shrink, while others may remain unchanged throughout life.
Are haemangiomas genetic?
While the exact cause of haemangiomas is not fully understood, research suggests that there may be a genetic component, as haemangiomas can sometimes run in families. However, no specific gene has been definitively linked to their development.
Written by Dr Samuel Heitner
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References:
https://dermnetnz.org/topics/infantile-haemangioma-definition-and-pathogenesis
https://www.rch.org.au/kidsinfo/fact_sheets/haemangiomas_of_infancy/