Infantile Hemangiomas

Infantile hemangiomas are benign (non-cancerous) tumors and are the most common type of vascular birthmark in infants and children. They are an overgrowth of immature blood vessels that may look like a red, purple or blue birthmark, depending on whether they are below the skin (blue/purple) or on top of the skin (red) as detailed below. Infantile hemangiomas are not fully formed at birth and, if present at all, will look like a faint purple patch or a patch of enlarged blood vessels with a rim of white. They usually appear during the first weeks of life.

Infantile hemangiomas can take on a different appearance depending on their location.

• A superficial hemangioma, colloquially called a “strawberry” hemangioma, has a bright-red color and well-defined border because it is on top of the skin.
• A deep hemangioma, also called a subcutaneous hemangioma, is located in the layer of fat beneath the skin. These have a bluish, lumpy appearance. These are similar to strawberry hemangiomas, and their blue color is due to their deeper location under the skin. This type may not be apparent until 1 or 2 months of age since it can take that long to make the regular skin rise.
• A mixed hemangioma is located in both the skin and the fat layers, and can take on a similar appearance to both superficial and deep hemangiomas.

In rare instances, hemangiomas may also develop in the organs, most commonly in the liver. Children with liver hemangiomas usually have more than five small hemangiomas on the skin; therefore, any child with five or more skin hemangiomas should have a liver ultrasound to evaluate for additional hemangiomas in the liver.

Infantile hemangiomas will typically grow rapidly during the first six months of life, with the most rapid growth occurring around 2 months of age. They then plateau between 6 and 12 months of age and then shrink over the next several (up to 10) years. Infantile hemangiomas are more common in girls, twins and multiplets, and babies who are born prematurely or who have low birth weight.

While some hemangiomas will go away on their own and do not require treatment, some may pose a risk for health problems or disfigurement. Because infantile hemangiomas grow rapidly during early infancy, they can cause a variety of health problems related to their location on the body. Ideally, children are seen within their first few months of life to try to prevent these issues.

Typically, a thorough medical history and physical examination are all that is needed to diagnose an infantile hemangioma. An imaging test such as an ultrasound may be used to determine the depth of the hemangioma and whether it affects any internal organs.

Most infantile hemangiomas will go away on their own and do not require treatment. When infantile hemangiomas have the potential to cause complications or are very large and disfiguring, the Comprehensive Vascular Anomalies Program (CVAP) at Children's Hospital of Philadelphia (CHOP) offers several treatment options. The most common treatment option is the use of  a group of medications called beta blockers, such as propranolol and topical timolol. These medications are extremely effective. They slow the growth of blood vessels in the hemangioma and usually prevent the need for more invasive therapies such as laser treatment or surgery.

The CHOP difference

Children seen by the CVAP team at CHOP benefit from a multidisciplinary team with extensive experience and deep expertise in the assessment and management of infantile hemangiomas. World-class specialists offer comprehensive care tailored to each child’s condition. The CVAP team at CHOP supports patients and their families every step of the way in their journey in managing a diagnosis of infantile hemangioma.