Hemangiomas are a common type of birthmark, often appearing shortly after birth. These growths, made of extra blood vessels, typically follow a predictable course of development.
What Are Hemangiomas?
Hemangiomas are benign (non-cancerous) vascular growths that form due to an overgrowth of blood vessels. They are the most common benign tumor found in infants and are often called “strawberry marks” due to their appearance.
These growths can appear on or under the skin and may be bright red and raised (superficial), bluish or purple beneath the skin (deep), or a combination of both. Though their exact cause is unknown, they are more common in females, premature babies, and those with low birth weight. Most hemangiomas become noticeable within the first few weeks of life, though some may be present at birth as a faint mark.
The Typical Growth Pattern
Hemangiomas generally follow a characteristic three-phase growth pattern: proliferation, plateau, and involution. Most hemangiomas will naturally shrink and fade over time without intervention.
The initial period is the proliferation phase, marked by rapid growth. This typically occurs during the first few months of life, with the fastest expansion often seen between 4 to 8 weeks and peaking around 6 to 9 months of age.
Following the rapid growth, hemangiomas enter a plateau phase. The growth stabilizes, and the lesion remains relatively consistent in size for several months.
The final stage is the involution phase, where the hemangioma begins to naturally shrink and fade. This process can start within the first year of life and continue for several years, often with significant resolution by ages 5 to 7. Many hemangiomas disappear almost completely by age 10, though some may leave behind minor skin changes like discoloration or stretched skin.
When Growth Poses Challenges
While the majority of hemangiomas resolve without complications, their growth can sometimes lead to challenges. The location of a hemangioma is a primary factor in determining if its growth might become problematic. For instance, growths near vital structures like the eyes can affect vision by obstructing sight or putting pressure on the optic nerve.
Hemangiomas located near the airway, such as in the throat, can interfere with breathing, a serious complication. Similarly, those around the mouth or on the lips can cause feeding difficulties or disfigurement. Rapid expansion, particularly on the face, can also cause significant disfigurement.
Beyond location, certain complications can arise regardless of where a hemangioma grows. Ulceration, where the skin breaks down and forms an open sore, is the most common issue, occurring in up to 15% of cases. Ulcerated hemangiomas can be painful, bleed, or become infected, and may lead to scarring. Very large hemangiomas may pose functional problems or require intervention.
Managing Hemangioma Development
For most hemangiomas, particularly those that are small and not causing any problems, observation is the primary approach. Given their natural tendency to involute, healthcare providers often recommend monitoring the growth over time.
When hemangiomas do pose challenges, such as interfering with function or causing significant complications, various treatment options are available. Oral medications, such as propranolol, are often the first-line treatment, working to slow or stop growth and accelerate involution. Topical medications, like timolol gel, may be used for smaller, superficial hemangiomas.
Laser therapy can be employed for certain issues, such as treating surface discoloration, persistent redness after involution, or ulceration. In rare instances where other treatments are ineffective or the hemangioma causes severe functional impairment, surgical removal may be considered. The decision to treat is carefully made, balancing the potential benefits with the risks and side effects of intervention.