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% of haemangiomas occur in the head and neck area, 25% occur in the trunk and 15% in 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 they are scratched. This is because the blood vessels are very close to the surface of the skin. Keeping fingernails cut short can help prevent scratches from happening.
If a haemangioma starts to bleed, apply pressure with a clean cloth or tissue for at least 5 minutes. If the blood soaks through place another one on top and keep the pressure applied. Do not take it off to look at it as this can restart the bleeding.
If the bleeding does not stop go to your nearest Accident and Emergency department or NHS Walk-In centre.
Making sure the the haemangioma doesn’t dry out is very important. Avoid bubble bath and rinse any soap off carefully and pat dry. Applying a thin layer of Vaseline® twice a day will aid this process.
Haemangiomas need protection from the sun because it can make them swell up for a while and look redder. Use a high factor sun cream on all areas of exposed skin and use a hat to protect the child’s face and/or an umbrella over the buggy or pushchair.
Occasionally, haemangiomas can form an open sore or ulcer, which is painful. Ulcers can become infected, so a visit to the doctor is important, as infected ulcerated areas may need treatment with antibiotics.
In the long term, an ulcerated area is more likely to leave a scar than a non-ulcerated area of haemangioma.
If the child’s haemangioma develops an ulcer, it will need special attention until it heals. Keep the area clean by washing it twice a day, preferably in a bath or by pouring water over the area, and leave it to dry naturally. Once the area is dry, cover the whole haemangioma with a non-sticky dressing. These are available on prescription from your GP.
Treatment
Most haemangiomas do not need treatment because they disappear completely by the age of seven, leaving either normal or slightly lighter-coloured skin. In some cases thread veins are also common; these are tiny red veins on the surface of the skin. Laser treatment can help with these later on in childhood.
Large haemangiomas may continue to get smaller until your child is about eight to ten years old. When they disappear, if the surrounding skin or tissue is distorted, plastic surgery can help.
Haemangiomas are often not treated actively as a large percentage will disappear over time.
However a haemangioma growing very quickly should be seen as early as possible and be considered for active treatment.
Many treatments are available and they have a varying degree of success. Not all are used at every centre, and the list below is to provide information only.
Propranolol (a beta-blocker) is now being used as an alternative to steroids, particularly if a patient cannot take steroids (e.g. after some immunisations, or if steroids have not been effective). Propranolol helps tighten blood vessels and reduce bloodflow through them, making haemangiomas become smaller and less red. Effects are usually seen very quickly. Read more about treating haemangiomas with propranolol.
Steroids were previously used as the primary medicine for slowing and stopping a haemangioma’s growth.
Laser therapy
Superficial haemangiomas can be effectively treated with a laser, which shrivels up blood vessels using heat and light.
Surgical removal
Surgery can remove complicated haemangiomas, however it leaves a scar and removing large haemangiomas has a potential risk of blood loss.
Bleomycin injection treatment
Bleomycin injections into the haemangioma are effective and the response rate is 77%.
Timolol topical cream
Is a topical beta blocker. Topical treatment is difficult to administer because the amount of medication absorbed depends on the size of the haemangiomas, and also the generosity of application. This the main reason why many specialists do not use this as a form of treatment. Some of our members are using this for their children and have had great results. Always talk through the different treatment options with your specialist.
PHACE syndrome
This can be the combination of a large haemangioma (usually on the face or neck) and one or more other abnormalities. PHACE is an acronym of the medical names of the body parts often affected:
P – Posterior fossa abnormalities and other 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 it affects girls nine times more often than boys.
This site does not provide medical advice and is
not a substitute for medical or professional care, and if you see a
birthmark growing or changing significantly, see a
specialist.