Hemangiomas, or infantile hemangiomas, are noncancerous growths of blood vessels. They’re the most common growths or tumors in children. They usually grow for a period of time and then subside without treatment.
They don’t cause problems in most infants. However, some hemangiomas may open and bleed or ulcerate. This may be painful. Depending on their size and location, they may be disfiguring. Additionally, they may occur with other central nervous system or spine abnormalities.
The growths may also occur with other internal hemangiomas. These affect internal organs such as:
- the liver
- other parts of the gastrointestinal system
- the brain
- organs of the respiratory system
Hemangiomas that affect organs usually don’t cause problems.
On the skin
Hemangiomas of the skin develop when there’s an abnormal proliferation of blood vessels in one area of the body.
Experts aren’t sure why blood vessels group together like this, but they believe it’s caused by certain proteins produced in the placenta during gestation (the time when you’re in the womb).
Hemangiomas of the skin can form in the top layer of skin or in the fatty layer underneath, which is called the subcutaneous layer. At first, a hemangioma may appear to be a red birthmark on the skin. Slowly, it will start to protrude upward from the skin. However, hemangiomas are not usually present at birth.
On the liver
Hemangiomas of the liver (hepatic hemangiomas) form in and on the liver’s surface. These can be related to infantile hemangiomas, or they can be unrelated. The non-infantile hemangiomas of the liver are thought to be sensitive to estrogen.
During menopause, many women are prescribed replacement estrogen to minimize symptoms caused by the decline of their natural estrogen levels.
This excess estrogen can spur the growth of liver hemangiomas. Similarly, pregnancy and sometimes oral contraceptive pills can increase the size of hemangiomas.
Besides the skin and liver, hemangiomas can grow on or compress other areas within the body, such as the:
Depending on the location and size, hemangiomas don’t normally cause symptoms during or after their formation. However, they may cause some symptoms if they grow large or in a sensitive area or if there are multiple hemangiomas.
Hemangiomas of the skin usually appear as small red scratches or bumps. As they grow, they look like burgundy-colored birthmarks. Skin hemangiomas are sometimes called strawberry hemangiomas because of their deep red appearance.
In the internal organs
Hemangiomas inside the body present with symptoms specific to the organ that’s affected. For example, a hemangioma affecting the gastrointestinal tract or liver may present with symptoms such as:
- abdominal discomfort
- loss of appetite
- a feeling of fullness in the abdomen
The diagnosis is usually by visual inspection on physical examination by a healthcare provider. Your doctor can make a visual diagnosis during a physical examination.
Hemangiomas on the organs may only be spotted during an imaging test, such as:
In some circumstances, they’re usually detected by chance.
A single, small hemangioma usually requires no treatment. It’ll likely go away on its own. However, some cases may require treatment, such as skin hemangiomas that develop ulcerations or sores, or are in specific areas on the face such as the lip.
Treatment options include:
- Oral propranolol: Oral propranolol is the first line of defense for hemangiomas needing systemic treatments. The U.S. Food and Drug Administration (FDA) approved hemangeol (oral propranolol hydrochloride) in 2014.
- Topical beta-blockers, such as timolol gel: These beta-blockers can be used for small, superficial hemangiomas. They may also have a role in treating smaller ulcerated hemangiomas. This medication is generally considered safe when used properly under the care of a healthcare provider.
Corticosteroids may be injected into a hemangioma to reduce its growth and to stop inflammation.
Systemic steroids, such as prednisone and prednisolone, are not typically used anymore. Although, they may have a role for those who cannot use other medications such as beta-blockers that are more typically used.
Laser treatment can be used to remove hemangiomas on the top layers of the skin. In some cases, a surgeon may use laser treatment to reduce redness and improve the appearance.
A medicated gel called becaplermin (Regranex) is expensive and has been used off-label in some studies as a treatment for chronically ulcerated hemangiomas. It carries a risk of developing cancer in people who receive it repeatedly. Talk to your healthcare provider about the risks.
If the hemangioma is small enough that it can be removed by surgery, your doctor may consider surgery an option.
For hemangiomas on the organs
Hemangiomas within the body may require treatment if they grow too large or cause pain.
Treatment options for these hemangiomas include:
- surgical removal of the hemangioma
- surgical removal of the damaged organ or damaged area
- In hemangiomas of the liver, tying off of the main blood supply to the hemangioma may be an option
More often than not, a hemangioma is more of a cosmetic concern than a medical one. Still, you should talk to a healthcare provider if you have any concerns or want to discuss removal.