What is a haemangioma of the skin?
A ‘haemangioma’ (Greek for blood-vessel-growth) of infancy is a benign (not cancerous) overgrowth of blood vessel cells that is self-limiting (will stop growing without treatment).
The term ‘strawberry naevus’ or ‘strawberry haemangioma’ is used for a haemangioma that looks similar to a strawberry.
What causes haemangiomas of Infancy?
The cause of haemangiomas is not understood. The cells lining blood vessels (endothelial cells) start to overgrow either when the baby is still in the mother’s womb or soon after birth.
Haemangiomas of infancy is more common in white children, females, premature infants with low birth-weight, twin/multiple pregnancies, and with increasing age of the mother.
Are haemangiomas of Infancy hereditary?
Haemangiomas of infancy do not usually run in families, but may rarely be inherited. They are relatively common, affecting about 5% (1 in 20) of babies.
How do haemangiomas of infancy look like?
In the majority of people, it affects the face, but any part of the skin or other organs can be involved. The appearance changes rapidly during early life. A small red mark or swelling may be visible at birth or develop during the first weeks of life.
This haemangioma may increase in size usually most quickly over the first three months. A further change is generally slower and gradual for up to twelve months. Usually, the haemangioma subsequently shrinks in size for up to 10 years (‘regression’).
However, some haemangiomas don’t grow much at all, and some do not shrink. Haemangiomas may be present mostly on the skin surface and appear red in color.
Those with a deeper component appear as a swelling underneath the skin and may have a bluish color.
Occasionally haemangiomas can be multiple, or they can be quite large and cover a large area of skin (segmental haemangioma).
When a haemangioma shrinks, there may be no visible mark left behind. Some may resolve with visible residual blood vessels. Others may leave a scar (mainly if there has been ulceration of the haemangioma), a pale area of skin, or an area of loose skin or thickened tissue.
What are the symptoms of haemangiomas of the skin?
Most haemangiomas do not cause any symptoms but can be alarming to parents and carers, especially during the phase of rapid growth.
Rarely the skin over the haemangioma breaks down (ulcerates), most often in the nappy area. This condition can be painful. Bleeding of the ulcerated skin may occur, but this is rarely severe and usually stops with the application of pressure.
Haemangiomas near the nose or mouth may cause breathing or feeding problems. Haemangiomas growing too close to the eye may interfere with the normal vision development, mostly if the swelling is closing or pressing the eye.
Children with more than five haemangiomas of the skin may rarely have haemangiomas involving internal organs, most commonly the liver. An ultrasound or other scan may be recommended.
Segmental haemangiomas tend to need more prolonged and more intensive treatment. They may be part of more widespread problems, in particular, if they affect the face, scalp, or back of the neck.
Children with haemangiomas over the midline of the lower back may require screening for underlying abnormalities of the spinal cord, inner organs, and genitalia.
How is a haemangioma of the infancy of the skin diagnosed?
The appearance can make the diagnosis of the haemangioma and the history of rapid growth followed by slow regression.
Sometimes scans will be organized to help confirm the diagnosis or to get further information about the extent of the haemangioma. For deeper or less typical lesions, a biopsy (skin or tissue sample) may be required to confirm the diagnosis.
Can haemangiomas of infancy be cured?
Most haemangiomas will gradually shrink or even entirely disappear without leaving a noticeable mark. Although many small haemangiomas clear up completely, with or without treatment, some permanent skin change can remain.
How can haemangiomas of infancy be treated?
Most haemangiomas do not require treatment except in the following situations: − If the haemangioma is unusually large or affects areas where resolution may be incomplete, such as around the nose, lips, or ears. − If the haemangioma is ulcerating (the surface of the skin is broken) − If the haemangioma is interfering with essential functions such as feeding or breathing or the development of senses: e.g., hearing or vision.
Treatment can consist of one or a combination of the following: –
A topical solution or gel applied directly to the haemangioma –
Medicines (orally by mouth or by injection) –
Laser therapy –
Surgery For haemangiomas that are still growing, topical or oral treatments are most often used.
Drugs called beta-blockers shrink blood vessels and can be used as a topical treatment or as an oral medicine: − Timolol can be applied as a solution or gel to the haemangioma. It has been proven to be safe and effective, especially for more superficial lesions −
Propranolol given by mouth is now the first choice to treat haemangiomas at important anatomical sites such as around the eyes or mouth. Heart rate, blood pressure, and blood sugar need to be monitored during treatment. Common side effects include constipation, diarrhea, cold arms and legs, and sleep disturbance.
Because propranolol can lower the blood sugar, it should be given during the day around feeding time and discontinued if the child is unwell. Almost all haemangiomas respond to propranolol. Treatment usually lasts for 6 to 12 months.
Steroid creams, injections, or tablets were frequently used before the discovery of the benefits of propranolol, but are now less commonly used.
Steroids may be used for children who cannot be given propranolol due to possible side effects. An ulcerating haemangioma needs additional treatment with non-adherent dressings and pain relief.
Laser therapy can be useful in treating ulcerated lesions.