Jan 26 2009
Hemangiomas
What are hemangiomas?
Hemangiomas are collections of extra blood vessels in the skin. They are common birthmark and are present in up to 10% of healthy full term newborns. They may not be visible at birth, but rather develop in the first few weeks of life. Initially they may look like a reddish-blue skin marking before they grow and become more apparent.
Hemangiomas take a special natural course: Once they are present, they show rapid growth for 6-12 months (proliferative phase). Then, they tend to stay stable with very little change for several months (plateau phase), before they slowly start to shrink (involution phase).
Though it is difficult to predict how one particular hemangioma is exactly going to behave, it is important to remember this natural course, especially during the time of rapid growth. We understand that this is very worrisome to parents, and we would like you to follow your child closely during those months and provide the needed support! The first signs noted when the hemangioma starts to resolve are a change of color from bright red/blue to grayish and no further increase in size. It may take months or years for the hemangioma to completely go away, but the cosmetic result at the end is usually excellent without any treatment. As a rule of thumb, clinical experience has shown that by age 3 years, 30% of hemangiomas have completely resolved; by age 5 years, 50% and by age 9 years, 90% will have gone away spontaneously.
Concerns about hemangiomas
Since hemangiomas can occur anywhere on the body and come in all shapes and sizes, there are some situations when they may cause problems and may need treatment.
Location is an important factor. if a hemangioma is found near the eye, nose, mouth, ear or buttocks, it may cause pressure and interfere with the normal function of important body parts. It may cause problems with vision, breathing, feeding and toileting.
Ulceration can occur during the rapid growth phase of a hemangioma. If this happens, it os often painful, will leave a scar and may get infected.
Bleeding of the hemangioma may happen, particularly if the area has been accidentally hit. Since a hemangioma is made up of many extra blood vessels, it tends to bleed heavily and this can be extremely frightening to parent. It is important to apply firm pressure to the area which will stop the acute bleeding in most cases!
Treatments
Steroids may be used as a cream, as medication by mouth, or injected into a hemangioma to help it shrink in size or stop further growth. Other systemic therapies may be recommended in exceptional cases.
Laser may be used to treat ulcerations, to hasten resolution of a hemangioma or to help with the cosmetic appearance of residual red coloration in a hemangioma. The laser selectively destroys the extra superficial blood vessels in a hemangioma. Over several treatment sessions, the area may appear lighter, and further growth may be prevented. These treatments are very effective in most cases and can often be given without causing significant pain to the child. There are numbing creams available that make the laser treatment relatively painless for the child.
Surgery may be an option in smaller lesions under certain circumstances, when a residual surgical scar may be preferable to the natural outcome of a hemangioma.
These options are available in cases where complications do occur. Most hemangiomas go through their natural course without causing problems and resolve by themselves without leaving a noticeable mark!
