Haemangioma of infancy

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Introduction

Haemangiomas (huh-man-jee-ow-muh) of infancy are common birthmarks caused by an overgrowth of blood vessels under the skin. They are usually seen within the first few days to weeks after birth and are usually harmless and disappear on their own over time. Sometimes medications are required to help shrink them.

Newborn baby with a large red vascular birthmark of superficial haemangioma on back of calf

Who gets it?

Haemangioma of infancy can be found in 1 in every 10 children in their first year of life. A newborn is more likely to get a haemangioma if they are:

A girl
Have light skin
Born before full term (premature)
Born when the mother was at an older age
Related to a family member who has or had a haemangioma
Part of a multiple birth (e.g. twins, triplets)

What causes it?

Haemangiomas are thought to occur from reduced oxygen supply to certain areas of the skin in the newborn. The body responds to this low oxygen supply by making more and bigger blood vessels so that more oxygen can be carried to skin areas with a lower oxygen supply. This collection of overgrown blood vessels made by the body are called ‘haemangiomas’. There are multiple different types of haemangiomas depending on their location of growth:

On the surface of the skin (superficial haemangioma)
Below the surface of the skin (deep haemangioma)
A combination of being both on the surface and deeper (mixed haemangioma)
Over a larger area of skin (segmental haemangioma)

What does it look and feel like?

Looks like...

Haemangiomas of infancy develop shortly after your child's birth and rapidly grow in size in the first three to six months - this is known as the growth phase.
They usually start as a flat red dot or patch that raises up as a red or purple lump in the next few days or weeks.
A deeper lump can sometimes form under the skin in some birthmarks. These are usually bluish in colour.
They usually grow slower from six months until your child is about nine months of age, although sometimes they may grow until your child is 18 months old - this is plateauing of growth.
Following this, they start to shrink with grey areas appearing within the birthmark and disappear over the next few years - this is the involution phase.
The surface of the lump may sometimes breakdown and form a sore (ulcer) which is red and can bleed.

Feels like...

It is a soft lump on or underneath the skin.
Usually your child will experience no pain or itch from the birthmark.
If there is eczema on top then it may become itchy or, if it ulcerates, there maybe pain.

What tests might be needed?

Most haemangiomas can be diagnosed by your doctor simply by looking at your child’s skin. If there is uncertainty in deciding whether this is one of the many blood vessel birthmarks or blood vesssel tumours, the doctor may order an imaging test to confirm the diagnosis or even do a small biopsy where a small piece of your child's skin is taken from the birthmark to send for testing. Tests may occasionally be required to see if deeper organs or the nervous system is affected. They are usually performed for haemangiomas that are:

Deeper within the skin
Located on skin above where the brain and spinal cord lies
Present on a large patch of skin (segmental)

An ultrasound is the most common test used, as it helps doctors look at the structure of the haemangioma and the tissue below it. Other tests such as an MRI or mapping out your child’s blood vessels (angiography) is rarely needed.

What treatments are available?

What can I do?

Avoid knocking or bumping the birthmark as this can cause bleeding
Apply a moisturiser regularly
Monitor the lump in case it ulcerates or bleeds

Medical Therapies

For most infants no treatment is required as the haemangioma should slowly shrink and disappear on its own. There are however some situations that haemangiomas do require treatment, as they can cause discomfort or impact on growth and development. These situations include haemangiomas that:

Are likely to breakdown and bleed (ulceration)
Block vision or hearing as they are located near the eyes or ear
Affect feeding or breathing
Grow over other areas and affect functions such as walking, hand function, etc
Are likely to grow very large and therefore cause stretching of skin
Are in cosmetically sensitive area such as face, nose and lips
Don’t start to shrink when your doctor expects them to
Have an abnormal shape or texture

In these situations, an oral medication called propranolol is usually given. This medicine fastens the shrinking time of the haemangioma. Sometimes, small haemangiomas can be treated with special drops or a gel, known as timolol, that can be applied to the surface of the haemangioma.

If the haemangioma has broken down and formed a sore, then laser treatment may be required to heal the area. Your doctor may also notice eczema over the birthmark and suggest creams to treat this so your child is not itchy from it. Surgery is not usually recommended.

What happens after treatment?

Most infants will experience shrinkage and complete disappearance of the haemangiomas (known as involution) on their skin, with or without treatment. Treatment simply fastens the shrinking process.

The skin at the area where the haemangioma was is usually normal in appearance. Sometimes there is a slight change in colour, fine thread like blood vessels or an area of stretched out skin. Usually a dermatolgist is able to treat these vessels with a laser when your child is older and a plastic surgeon can cut out the excess skin. These procedures are usually best delayed until your child is about to start school.