Infantile hemangiomas, commonly known as strawberry birthmarks, are benign growths on a baby’s skin. They are common, affecting approximately 4% to 10% of infants. While often concerning to parents, most are harmless and resolve without intervention. However, certain situations and characteristics warrant medical evaluation.
Understanding Strawberry Birthmarks
Strawberry birthmarks are benign vascular tumors, non-cancerous growths made of blood vessels. They are typically bright red and raised, resembling a strawberry, especially when superficial. Deeper ones may appear as bluish or purplish lumps.
They usually emerge within the first few weeks or months of life, often noticeable by 2 to 4 weeks. Infantile hemangiomas undergo a characteristic growth pattern: a rapid proliferation phase in the first few months, peaking around 3 to 5 months (reaching about 80% of maximum size). After this, they enter a slower regression or involution phase, gradually shrinking and fading. This process can continue for several years, with many resolving by ages 3 to 7.
They can appear anywhere, though most frequently on the head and neck (about 60% of cases), trunk, or extremities. Most infants develop only one, but some may have multiple. The majority disappear on their own, often without medical treatment.
Key Indicators for Concern
While most are benign and self-resolving, certain features or locations necessitate medical evaluation. Location is concerning if it interferes with vital functions or is in an area prone to complications. For instance, birthmarks near the eyes can obstruct vision, potentially leading to permanent sight issues. Hemangiomas around the nose or mouth might interfere with breathing or feeding. Those in the ear canal could affect hearing, and any in the diaper area or skin folds are more susceptible to ulceration due to friction and moisture.
The size and growth pattern are also important indicators. Rapid, unusually large growth, or growth extending deep into tissues, can signal a need for intervention. If a birthmark poses a risk to surrounding structures or causes significant disfigurement, medical consultation is recommended.
Complications such as ulceration, a breakdown of the skin over the hemangioma, are common and can be very painful. Ulcerated hemangiomas risk bleeding and infection, requiring immediate medical attention. Signs of infection include increased redness, warmth, swelling, or pus. Functional impairment caused by the birthmark, such as difficulty seeing, hearing, eating, breathing, or moving a limb, also warrants urgent evaluation.
The presence of multiple birthmarks, especially five or more, can indicate internal hemangiomas, particularly in organs like the liver. This condition, known as hepatic hemangiomatosis, can be associated with systemic issues like heart failure, making medical assessment crucial. Any atypical features or unusual appearance should also prompt a medical review to rule out other conditions. These indicators guide healthcare providers in determining the appropriate course of action.
Managing and Treating Problematic Birthmarks
When a strawberry birthmark is problematic, medical professionals typically conduct a thorough physical examination. In most cases, this clinical assessment is sufficient for diagnosis; imaging studies are usually not needed unless diagnosis is uncertain, multiple lesions exist, or underlying structural anomalies are suspected. For most hemangiomas without concerning features, continued observation is the primary management strategy, as they tend to resolve on their own.
If intervention is necessary, medical treatments are employed to prevent complications or accelerate involution. Oral beta-blockers, such as propranolol, are the first-line medical therapy for problematic hemangiomas. Propranolol constricts blood vessels and slows abnormal cell growth, leading to faster shrinkage. Topical beta-blockers, like timolol, may be used for smaller, superficial lesions.
Other treatments include laser therapy, useful for ulcerated lesions to promote healing, or for addressing residual redness and visible blood vessels (telangiectasias). Surgery is rarely required, typically reserved for specific circumstances like airway obstruction, persistent cosmetic disfigurement, or removing excess skin after involution. The goal of treatment is to prevent complications, ensure functional integrity, and improve cosmetic outcomes.
Long-Term Outlook and What to Expect
The long-term outlook for children with strawberry birthmarks is generally favorable, even for those requiring treatment. While most hemangiomas shrink and fade significantly over several years, complete disappearance without any trace is not always the outcome. Some birthmarks, especially larger or ulcerated ones, may leave residual skin changes like light scarring, discoloration, stretched skin, or visible blood vessels.
The process of involution can take considerable time, with significant resolution often seen by ages 3 to 5, and continued improvement up to age 7 or 9. Even with these potential residual changes, most children lead healthy lives with minimal long-term issues. Continued monitoring by a healthcare provider is important for any remaining cosmetic concerns or if functional issues persist. This approach ensures that any lasting effects are managed appropriately, allowing for the best possible outcome.