Infantile hemangiomas, often recognized as “strawberry marks” on babies, are common, non-cancerous birthmarks. While their appearance can be concerning for new parents, these marks are generally harmless and frequently resolve without intervention.
What Are Infantile Hemangiomas?
Infantile hemangiomas are the most common benign tumors observed in infancy, consisting of extra blood vessels in the skin. They typically appear as raised, bright red, and rubbery bumps. These marks are frequently found on the head and neck, though they can occur anywhere on the body. While superficial hemangiomas present as bright red, deeper ones can appear bluish or skin-colored. They are present in approximately 4% to 5% of newborns.
Factors Contributing to Their Development
The precise cause of infantile hemangiomas is not fully understood. Research indicates they arise from an abnormal development and proliferation of blood vessels, possibly linked to cellular signals or hypoxic stress during pregnancy or early infancy. Babies born prematurely or with a low birth weight have an increased chance of developing these marks. Female infants are also more commonly affected than males. Infantile hemangiomas are not inherited and are not caused by any actions or inactions of the mother during pregnancy.
Typical Growth and Fading Patterns
Infantile hemangiomas follow a predictable pattern of development, characterized by two main phases. The first is a rapid growth, or proliferative, phase, typically beginning within the first few weeks of life. During this period, most hemangiomas reach about 80% of their maximum size by three months of age and continue to grow substantially for the first four to six months. Following the proliferative phase, the hemangioma enters a slower shrinking, or involution, phase. This process involves the gradual flattening and fading of the mark, as the bright red color may change to a duller hue. Involution can continue for several years, with many hemangiomas resolving completely by five to ten years of age. Some may leave behind minor residual skin changes, such as slight discoloration or textural differences.
Situations Requiring Medical Evaluation
If a hemangioma interferes with a baby’s vital functions, such as vision, breathing, or feeding, a doctor should evaluate it promptly. This includes marks located near the eyes, nose, mouth, or in the airway. Medical attention is also advised if the hemangioma becomes ulcerated, bleeds, or shows signs of infection. Additionally, hemangiomas in sensitive areas like the diaper region or those that are particularly large, especially on the face, may require evaluation due to potential for complications or disfigurement. Multiple hemangiomas might also indicate a need for further assessment to rule out internal involvement.
Approaches to Care
For the majority of infantile hemangiomas, careful observation without active medical intervention is the primary approach. When treatment is considered necessary, decisions are based on the hemangioma’s location, size, and any potential complications it may present. Oral medications, such as propranolol, are often a first-line treatment for more problematic hemangiomas and are approved for use in infants. Topical treatments, like timolol, may be applied directly to smaller, superficial lesions. Laser therapy is sometimes used for specific purposes, such as addressing ulcerated areas or improving residual skin changes after the hemangioma has largely faded.