Learn about skin disease
Frequently Asked Questions:
1. What are infantile hemangiomas?
Infantile hemangiomas—nicknamed strawberry hemangiomas, strawberry birthmarks, or simply hemangiomas—are harmless growths of microscopic blood vessels. They usually start out as a tiny red speck on the skin at or within a few weeks after birth. They grow rapidly during early infancy and slowly shrink and fade over the toddler and school-age years. They are NOT cancer.
They look like they are “blood blisters” that will pop and bleed if disturbed. However, hemangiomas are actually solid. The bright red color comes from the many tiny blood vessels that make up the hemangioma. They look like they are painful but are not. Some of them may be slightly sore if pressed upon, but this is only when they are growing rapidly.
2. What can infantile hemangiomas look like?
Infantile hemangiomas come in different shapes, colors, and sizes.
The blood vessels can be very close to the skin surface, which causes the bright strawberry red color and bumpy strawberry texture.
Or the blood vessels can be deep in the fat of the skin, causing the hemangioma to look purple, blue, or skin-colored and be a smooth bump that protrudes from the skin surface.
60% of the time, they are found on the head or neck. But they can be found anywhere on the skin. Sometimes they are also found in the airway or on internal organs (see question 5 below).
3. It keeps growing bigger. When will it stop growing and start shrinking?
Nobody can accurately estimate how big your child’s hemangioma will become, because every hemangioma is different, but most hemangiomas reach the maximum size and stop growing by the time your child is 4 to 6 months of age. They can remain the same size for 6 to 12 months before starting to shrink, but some start shrinking right after they finish growing.
4. Why does my child have a hemangioma? Did I make this happen?
No one knows why some children develop hemangiomas. They are more common in girls, premature babies, and in twins and triplets. There is nothing you did during your pregnancy or after that caused your child’s hemangioma.
5. Is it a sign of something worrisome happening inside?
80% of the time, children have only one hemangioma on the skin. A solitary hemangioma is NOT a sign of another disease process. Children who have many (usually more than 5) hemangiomas on the skin are at slightly increased risk of having hemangiomas in internal organs, most commonly in the liver. Your doctor may order imaging studies to see if your child has any hemangiomas inside her/his body. Fortunately, the majority of hemangiomas inside the body rarely require treatment and go away on their own just like the ones on the skin.
Hemangiomas on the middle of the lower back or ones that cover a large area on the head and or neck can be associated with other birth defects inside the body. If your infant has a hemangioma in one of these locations, he/she should be evaluated by a pediatric dermatologist.
6. What should I be on the watch for in my child’s hemangioma?
Hemangiomas are harmless growths and they don’t hurt. Sometimes they can be a nuisance if they rub against surfaces, such as shirts. If the hemangioma is on the infant’s face then the parents often have to deal with comments from strangers. This can be a source of anxiety for parents. If it develops a sore (called an ulcer), which ispainful it should be treated as soon as possible. These sores always leave some form of a scar.
If the hemangioma is located near the eye, mouth, lip, ear, or in the diaper area, it can obstruct normal function or develop a sore. If it involves the central face it can leave a mark or scar behind after it goes away. Usually these hemangiomas are evaluated by a dermatologist or pediatric dermatologist, and if appropriate they are treated to halt further growth or to make them to go away faster.
Occasionally they can bleed. Do not be alarmed if your child’s hemangioma bleeds, since it is rarely life-threatening. Try to get your child to stop crying (especially if the hemangioma is on the head or face), apply direct pressure with a clean cloth or sterile non-stick dressing (like Telfa) for 10-15 minutes to stop the bleeding, and call your child’s doctor.
7. What are the different ways to treat this?
Most hemangiomas that have not developed a sore, are not on the mid face or in the diaper area, and are not obstructing function can be closely observed by you and your doctor without active intervention. Hemangiomas go away on their own over time.
The medications most commonly used to treat hemangiomas are beta blockers, which is a class of medications used to treat blood pressure and glaucoma in adults. The two beta blockers that can be prescribed for hemangiomas are propranolol (taken by mouth) or timolol (an eye drop that is rubbed on the surface of the hemangioma). Other treatments include laser therapy, glucocorticosteroids (like prednisone) either injected into the hemangioma or given by mouth, and surgery. Your doctor will go over your child’s treatment options in detail and explain the risks and benefits associated with each treatment.
8. What happens to a hemangioma over time if you don’t treat it?
It fades to normal skin color and flattens out. Sometimes it leaves no trace. Sixty percent of the time it leaves a residual footprint in the skin, like a scar, discoloration, a little loose skin, a fatty bump (usually for the larger hemangiomas in the fat) or small spidery red blood vessels on the surface of the skin.
See some real-life examples below of infantile hemangiomas and how they have gone away (without treatment unless indicated) over the course of months and years:
Hemangiomas near the Eye(s):
Hemangiomas on the Lip:
Hemangiomas on the Face:
Hemangiomas on the Scalp:
9. Does my child need surgery?
This is a conversation you should have with your physician. Sometimes hemangiomas need to be removed by surgery because medical therapies aren’t working and the hemangioma is interfering with normal function, like obstructing vision. Other times, parents may want to have the hemangioma removed for cosmetic reasons. Any surgery will leave your child with a scar.
10. If my physician and I decide not to treat the hemangioma, should I do anything special for it?
Just keep watching it to make sure it doesn’t develop a sore. You don’t need to put any special creams or ointments on it. It is not more sensitive to sunlight than the rest of the skin. You should, of course, put sunscreen on it and the rest of your child’s skin if your child spends time in the sun.
11. Can it come back?
No, once it fades, it does not grow back.
12. If I have more children, are they at risk for developing a hemangioma?
There is a chance that another child will develop a hemangioma, because hemangiomas are common and they occur in about 4-5% of all children. Even if your first child has a hemangioma, your subsequent children will still all have approximately 1 in 20 chance of having one as well.