< Vascular Anomalies - Conditions

Hemangiomas  (Birthmarks)

What are hemangiomas?

Hemangiomas are blood vessel growths on or under the skin shortly after birth. Although they most often occur on the head and neck, hemangiomas can appear anywhere on the skin or inside the body. They are generally more common in girls than boys.

There are a few types of hemangiomas:

  • Capillary hemangiomas: are the most common and appear on the surface of the skin
  • Cavernous hemangiomas: grow deeper inside the skin
  • Combined hemangiomas: grow deep in the skin, but a part of the hemangioma also appears on the skin’s surface

In most cases, hemangiomas shrink on their own and fully disappear by age 10. Most need no treatment, but a hemangioma can become a problem if it becomes infected, bleeds. Sometimes the location of a hemangioma can affect your child's vision, breathing or hearing.

In rare cases, large hemangiomas on the face or neck may be a sign of PHACE syndrome, a condition that can affect the heart, eyes and brain.

What are the symptoms of hemangiomas?

Hemangiomas often start as faint red marks and become bright red in the first few weeks of life. Common symptoms of hemangiomas in children include:

  • A bright red patch on the skin that may be flat or raised
  • A mass or swelling under the skin that may appear blue

Children usually only have one hemangioma but can sometimes have more. If your child has many hemangiomas on the skin, it could be a sign they are also growing on their liver. If this occurs, your child's doctor may order tests to check their liver.

What causes hemangiomas?

Experts do not know what causes some children to have hemangiomas.

How are hemangiomas treated?

Most hemangiomas will shrink on their own and will not need treatment. Your child may need treatment if the hemangioma causes problems with vision or breathing or if it becomes infected or bleeds. Your care team at Arkansas Children's is experienced in treating hemangiomas and will work with you to come up with the best treatment plan for your child. Treatment options may include:

  • Propranolol, a type of beta blocker medicine that can help reduce the size of the hemangioma
  • Laser therapy to remove small blood vessels or decrease pain
  • Surgery to remove the hemangioma

Infantile hemangiomas are tumors containing small abnormal blood capillaries that resemble placental tissue. They then grow intermittently, and sometimes quite rapidly, throughout the first 10 -12 months of life. There is usually no more growth after a year of age, and the hemangioma starts its involutional phase. In this phase, the hemangioma can shrink and lighten in color, or it may not appear to do anything. 

Infantile hemangiomas can be classified by the areas they involve. Superficial hemangiomas involve skin only.

  • Deep hemangiomas involve the layers of tissue below the skin and can vary in color from deep purple/blue to skin tones if they are really deep.
  • Compound hemangiomas involve both the skin and deeper tissues.
  • They are vascular birthmarks that usually appear within the first few weeks of birth. Some may even be seen as a small red mark or bruise at birth.

How are infantile hemangiomas treated?

Depending on the size of the hemangioma, this shrinking is frequently not enough to make the lesion "go away." A large percentage of hemangiomas will require some form of intervention to correct the deformity caused by the growth of the hemangioma or to correct scarring caused by ulceration. Treatment options include medical therapy with Propranolol, beta-blocker therapy, a topical treatment known as Timolol, laser therapy or surgical removal.

Congenital hemangiomas are fully formed at birth, and they usually don't grow anymore, but they may or may not involute (shrink). There are two types of congenital hemangioma:

  • RICH (rapidly involuting congenital hemangioma)
  • NICH (non-involuting congenital hemangioma)

Like each of their names implies, one tends to go away rapidly, and the other doesn’t change at all.

Still, surgical removal is required the hemangioma does not shrink on their own.

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