Haemangioma
What is a haemangioma?
A haemangioma is a collection of blood vessels that form a lump under the skin; it’s often called a ‘strawberry mark’ as it looks like the surface of a strawberry.
Superficial haemangiomas are usually raised, red areas of skin, which feel warm because the blood vessels are close to the surface. They can initially appear as a small area of pale skin where a red spot develops.
Deep haemangiomas are blue in colour because the blood vessels are deeper in the skin. You can’t usually see them for the first few weeks as they only show a lump as the haemangioma grows.
How common are they?
About one in every ten babies has a haemangioma. They are more common in girls, premature babies, low birth weight babies and multiple births, such as twins.
Most appear during the first few weeks and grow rapidly for 6–12 months (the proliferative phase). Then they begin a process of shrinking (the involuting phase), which can take one to seven years. The majority of haemangiomas only grow to the size of 1 or 2 pence coin but a few can grow much bigger.
Where do they occur?
Haemangiomas can appear anywhere on the body. Approximately 60% occur in the head and neck area, 25% on the trunk, and 15% on the arms or legs.
They can also appear on internal organs – this is more common when a child has multiple haemangiomas, and an ultrasound scan can confirm this if a child has 3 or more. The liver is most commonly affected, but the airway, heart and brain are occasionally affected.
How are they diagnosed?
Superficial haemangiomas are quite different to other types of birthmark and easily recognisable, so no special diagnostic tests are usually needed.
A deep haemangioma, one near the eye or on internal organs often needs ultrasound and/or MRI scans to confirm diagnosis, location, and to check the depth of the affected blood vessels.
Protection and ulceration
In most cases, haemangiomas need looking after carefully.
- Haemangiomas can bleed if scratched. Keeping fingernails cut short can help prevent scratches.
- If a haemangioma starts to bleed, apply pressure with a clean cloth or tissue for at least 5 minutes. If bleeding does not stop, visit an A&E department.
- To prevent drying out, avoid bubble baths, rinse soap carefully, and apply Vaseline® twice a day.
- Haemangiomas need sun protection as exposure can make them swell and look redder. Use high-factor sunscreen and hats.
- Ulceration can be painful and may lead to scarring. Keep the area clean and use non-sticky dressings.
Treatment
Most haemangiomas disappear by the age of seven, leaving either normal or slightly lighter-coloured skin. Some treatments include:
- Propranolol: A beta-blocker that reduces blood flow, shrinking the haemangioma.
- Steroids: Previously the primary medicine to slow haemangioma growth.
- Laser therapy: Effective for superficial haemangiomas.
- Surgical removal: Used for complicated haemangiomas but may leave a scar.
- Bleomycin injection treatment: Has a 77% response rate.
- Timolol topical cream: A beta-blocker applied directly to the skin.
PHACE syndrome
PHACE syndrome is the combination of a large haemangioma (usually on the face or neck) and one or more other abnormalities:
- P – Posterior fossa abnormalities and structural brain abnormalities
- H – Haemangioma(s) of the cervical facial region
- A – Arterial cerebrovascular anomalies
- C – Cardiac defects, aortic coarctation and other aortic abnormalities
- E – Eye anomalies
PHACE syndrome is uncommon but affects girls nine times more often than boys.
Disclaimer
This site does not provide medical advice and is not a substitute for medical or professional care. If you see a birthmark growing or changing significantly, see a specialist.