Introduction
Haemangiomas are common birthmarks that happen when there is an overgrowth of cells in the blood vessels. They are sometimes called 'strawberry birthmarks' due to the red, purple, and blue colour.
Haemangiomas can occur anywhere on the body but are more common on the head and neck areas.
Most haemangiomas will go away on their own over time. Some may require further treatment.
Signs and symptoms
Haemangiomas are identified by the look and feel of the affected skin. They will usually appear within the first 3 weeks after birth. They can appear all over the body but are mostly found on the face.
Three types of haemangiomas include:
- superficial: flat, bright red and a raised, uneven surface
- deep: blue-purple coloured swelling under the skin with a smooth surface
- mixed: a combination of signs shown in in superficial and deep.
Diagnosis
Your child’s doctor will be able to make a diagnosis by examining the mark. They may also refer your child to a dermatologist or paediatrician.
It is important that you let your child’s doctor know if you see any marks on the skin especially around the face, bottom, and genitals that look like a haemangioma. You will also need to let them know if you think your child’s haemangioma has changed or is bleeding.
Treatment
Haemangiomas will usually appear within the first 3 weeks after birth and can continue to grow rapidly for 2-3 months. Growth will start to slow down from 3-4 months. The haemangioma will then settle, before slowly starting to fade and shrink at around 1 year of age. The mark may start to look grey in colour. This means the blood vessels are shrinking. The mark should be flatter and lighter by the time your child is 5 years old and will be only faintly visible or gone completely by 10 years old.
Some haemangiomas may be sitting too close to organs like the eyes and ears. When this happens there is a risk injury to sight or hearing, cause damage to the skin if the growth is large. Treatment options may include the following medications and procedures.
Propranolol
Your child may be referred to a paediatrician or dermatologist who can treat haemangiomas with a drug called propranolol.
Propranolol can make the blood vessels smaller, which restricts the blood flow to the growth. This makes it good at preventing further growth and speeding up the shrinking process.
Babies will need to have a cardiac check before being starting treatment. Their blood pressure and heart rate will be closely checked before, during and after treatment.
Propranolol can decrease your baby’s response to low blood sugar, so their blood sugar levels will need to be checked closely if they are unwell and not eating or drinking.
Corticosteroids
Corticosteroids are anti-inflammatory medications that can be given if your baby is not responding to or cannot take propranolol.
These medications will slow the growth of the haemangioma and are only useful at 2-4 months of age while the haemangioma is growing. They have no effect on the shrinking the haemangioma. High doses of corticosteroids in babies will be managed by a paediatrician.
Surgery
Haemangiomas can be removed by surgery if your child is under 1 year old and the haemangioma is likely to cause damage. Surgery is commonly delayed until the haemangioma has shrunk as much as it can naturally. Surgery may also be required later to manage any scarring or loose skin left behind.
Laser therapy
Haemangiomas can be treated with laser therapy very early on when they are still flat. Laser therapy can also be useful for to manage the look of the skin after the mark shrinks.
Management
Complications
Sometimes haemangiomas of infancy can interfere with the function of vital structures, including:
Eyes
A haemangioma that closes the eye or presses on the eye in the early weeks of life can cause permanent damage to your baby’s vision.
Mouth
Large haemangiomas around the mouth can interfere with sucking and feeding.
Nose and airways
Large haemangiomas that are low on the face, neck or in the mouth can affect the airways and interfere with feeding.
Contact your local doctor immediately or present to your nearest emergency department if your baby has a haemangioma on or around their nose and airways and makes noises when breathing.
Support
In most cases haemangiomas will have no complications and go away completely.
In some cases where a haemangioma is large or in a prominent position like on the face, it can be good for parents to talk to their doctor about the condition and how they can respond to people who may be curious about the mark. It is important for parents to talk with their child about the haemangioma, to answer any questions and to promote good self-esteem.
Parents should also speak to their doctor for support if they are struggling with the appearance of their child’s haemangioma or struggling with the time it takes to shrink and fade.