Hemangioma

A hemangioma (Hee-MAN-jee-oh-ma) is a common type of birthmark. It is a benign (non-cancerous) growth in the skin cells. The exact cause is not known. Hemangiomas are not inherited, but others in the family may have had them also. The color will vary, depending on the depth of the hemangioma. They are more common in girls than in boys, and more common in premature infants and twins.

Most hemangiomas appear during the first weeks of life and grow rapidly for 6 to 12 months. After the period of rapid growth, the hemangioma begins to slowly shrink and fade in color over the next 1 to 10 years. Many go away completely during this time. By the age of 5, half of all hemangiomas will be flat and lighter in color. By age 10, nearly all are gone or only faintly visible. Some hemangiomas leave behind fatty tissue or thin skin in areas that were previously stretched out by the hemangioma. If left over skin changes are noticeable there are procedures including surgery and laser treatments that may be used to correct the changes when the child is older.

Types of Hemangiomas

Hemangiomas may occur anywhere on the body; some children may have more than one. They may also develop inside the body, but this is rare. They never develop in an adult.

There are three main types:

Congenital (present at birth) - begins in the womb and is fully present at birth. This type of hemangioma can shrink rapidly in the first year of life.
Superficial (on the surface of the skin) - looks flat at first, and then becomes bright red with a raised, uneven surface.
Deep (under the skin) - appears bluish-purple; has a smooth surface and is deeper in the skin.

Many hemangiomas have both superficial and deep parts.

Diagnosis

The doctor can usually look at your child’s skin and tell if there is a hemangioma. If the diagnosis is not clear, an ultrasound scan or MRI test may be needed.

Treatment

Most hemangiomas go away over time without any treatment. If the hemangioma is causing a problem, treatments are available and may include:

Topical medicine (rubbed onto the hemangioma):

Topical beta blockers - these may help lighten the hemangioma and slow its growth.
Topical antibiotics - these are applied when open sores are present.

Oral medicine (taken by mouth):

Propranolol: Your child will be watched closely for side effects. Your doctor will order any tests or studies needed before starting this medication.
Prednisone: Your child will be watched closely for side effects. While he or she is taking prednisone, the doctor may also prescribe other medicines to prevent infections and reflux.

Injected medicine (taken as a shot directly into the hemangioma)

Surgery to remove the growth

Your doctor will talk with you about the best choice for your child.

When Treatment Is Needed

The hemangioma may need to be treated if:

It causes problems with normal activities such as eating, seeing, breathing, hearing or diaper changes.
It gets infected (especially if it is in the diaper area).
The skin “breaks down” and an open sore forms.

When to Call Your Child’s Doctor

Call your child’s doctor if any of these things occur:

The area looks infected: pus, redness or pain is present and your child has a fever over 101 degrees F (under the arm).
The skin breaks down, looks open or oozes (ulcerates).
Your child acts like the area is painful.
Fever over 101degrees F (under the arm).
You have concerns about a hemangioma medicine, such as:
- You run out of the prescribed oral medicine.
- Your child refuses to take the medicine.
- You are concerned about possible side effects from the medicine.
- Your child is drowsy, fussy, wheezing or having noisy breathing, not eating well or has fever and illness while on the oral medicine.

If your child is on oral steroids, the medicine must never be stopped suddenly. Be sure to get the prescription filled before your child takes the last dose. The doctor will give you exact instructions on how to slowly stop the medicine when it is time to do so.

Follow-Up Appointments

The doctor needs to watch your child’s progress so it is important to keep follow-up appointments.

For more information, please visit www.birthmark.org.

Hemangioma (PDF)

HH-I-310 6/0 Revised 4/12 Copyright 2009-2012, Nationwide Children's Hospital