What is a hemangioma of the skin?
A hemangioma of the skin is an abnormal buildup of blood vessels on or under the surface of the skin. A hemangioma of the skin may look like a red-wine or strawberry-colored plaque, and it may protrude from the skin.
Infantile hemangiomas are a specific type of hemangioma that appear most frequently on the trunk of the body, but they can also appear on the face or neck. They generally develop soon after birth and can affect both boys and girls.
Hemangiomas can occur on the top layer of the skin or deeper in the body. Treatment depends on a multitude of factors including:
- whether or not they’re ulcerated
Hemangiomas look painful, but they don’t typically cause any discomfort. After a brief period of rapid growth, they often shrink on their own without treatment. They’re noncancerous and complications are very rare.
Experts don’t know why these benign tumors form. However, they’re more common in:
- infants with low birth weight
- premature infants
- Caucasian infants
Historically, infantile hemangiomas were thought to be more common in females, but this is not always observed. In some cases, hemangiomas run in families. They can also appear spontaneously, so there may be a genetic component to the condition.
There’s no way to prevent hemangiomas of the skin because their exact cause is unknown.
Hemangiomas of the skin are generally deep red or blue-purple. They appear as raised lesions or tumors on the skin. The deeper the hemangioma, the darker it’s color.
Growths on the skin’s surface (strawberry, capillary, or superficial hemangiomas) are usually deep red. Growths under the skin’s surface appear as blue or purple spongy masses filled with blood.
Hemangiomas are usually small, but they can grow to be quite large. They normally begin as small spots or red patches on the skin that form during the first 2 or 3 weeks of life. Hemangiomas in infants tend to grow rapidly for the following 4 to 6 months.
After this period of growth, hemangiomas enter a resting phase. They usually remain the same size for several months or years and then begin to shrink.
A healthcare provider can diagnose a hemangioma of the skin just by looking at it. No other testing is usually necessary.
Your healthcare provider may order blood tests or a skin biopsy if a growth appears to be abnormal or other sores are present. A skin biopsy involves removing a small piece of skin for testing.
An MRI or CT scan is a way to examine a deeper hemangioma. These scans allow healthcare providers to visualize structures beneath the skin to see how deep the hemangiomas have grown and if they affect other structures in the body.
Your healthcare provider may also use a Doppler ultrasoundto see how blood flows through a hemangioma. A Doppler ultrasound may also help determine if the hemangioma is growing, resting, or shrinking.
Superficial hemangiomas aren’t usually treated. As the child gets older, the growth tends to shrink and will usually disappear on its own.
If a hemangioma is in an area that could interfere with sight or breathing, treatment may be necessary. Treatment might also be necessary if the hemangioma is very large or breaks open and bleeds, causing discomfort.
Treatments can shrink or remove the growth. Laser surgery can remove a large hemangioma of the skin that’s uncomfortable or is causing problems. Laser treatments can also reduce remaining discoloration after a hemangioma has healed.
Your healthcare provider may also prescribe topical timolol maleate to treat thin or superficial hemangiomas.
Oral propranolol is the first-line treatment for hemangiomas needing systemic treatment.
If the hemangioma doesn’t adequately respond to propranolol or there’s a reason this medication can’t be used, corticosteroids, such as prednisone, can slow or stop the growth. They may be given:
- applied topically
- injected into the hemangioma
The potential side effects of steroids are serious and may include:
- poor growth
- high blood sugar
- high blood pressure
These side effects are given careful consideration before being prescribed. Severe side effects of propranolol may include:
- low blood pressure
- low blood sugar
- difficulty breathing
A medication called vincristine, which is used for other types of tumors, is also sometimes used to treat infantile hemangiomas that are unresponsive to other treatment methods.
Complications from hemangiomas are extremely rare. However, they can occur if a hemangioma grows very quickly or is in a dangerous location. Potential complications include:
- ulceration (bleeding)
- vision changes (if the hemangioma is on the eye)
- difficulty breathing (if the hemangioma is large, and on the throat or nose)
- secondary infection
Most hemangiomas will go away by themselves in time. If you decide that your child needs treatment, discuss options with your healthcare provider.
Treatment depends on careful evaluation and observation by a healthcare provider.