TEXAS CHILDREN'S DERMATOLOGY CLINIC
What are Infantile Hemangiomas?

Texas Children's Dermatology Clinic Dermatology clinic home Infantile hemangiomas Hemangioma research PHACE syndrome patient registry See also Other PHACE studies: PHACE genetic study PHACE head imaging study (pdf) A patients' experience: Kaylee's story (alopecia areata) Curriculum vitae: Denise W. Metry, M.D. Curriculum vitae: Alanna Flath Bree, M.D.

Hemangiomas are very common growths of the skin that are made of small blood vessels. They are benign (not cancer). Up to 1 of every 10 babies will have a hemangioma. Usually hemangiomas are noticed on the skin within a few days to weeks after birth. At first they are often mistaken for a “scratch” or “bruise”. They can occur anywhere on the skin, but are most common on the head and neck. Most will grow for about 6 to 12 months, but most of the growth usually takes place in the first 3 to 4 months of life.  Hemangiomas then slowly shrink over a number of years, and many go away completely, but how fast a hemangioma shrinks is hard to predict and differs between children. 

What exactly causes hemangiomas is not known, though they are known to be more common in girls, low birth weight babies, Caucasians and twin/triplet pregnancies. Hemangioma tissue is similar to placental tissue, and researchers are currently exploring what exactly the relationship between these two tissues might be.

Most hemangiomas cause no problems and most don’t need treatment. Some of the uncommon problems hemangiomas may cause include:

1. Ulceration (when the skin surface of a hemangioma breaks down and forms a sore). This most commonly happens early in infancy, when hemangiomas are growing, and is more likely to happen when the hemangioma is in a location prone to trauma (for example, lip, diaper area, buttock, back of head). Serious ulceration can be painful and lead to bleeding (though usually minor), infection, and scarring.

2. Location around the eye that blocks an infant’s vision. This usually requires evaluation by a specialist(s), often including an eye doctor (ophthalmologist).

3. Very large hemangiomas can rarely be associated with other birth defects. For example, hemangiomas over the skin of the center lower back can be associated with defects of the spinal cord. Large hemangiomas of the face can rarely be associated with birth defects of the brain, heart or eyes, also known as PHACE syndrome.

4. Hemangiomas of the internal organs (liver, intestines, brain) can occur, but it is believed that most go away without problems, just like they do on the skin. It is known that multiple (more than 5) small hemangiomas or one large hemangioma of the skin can be a sign of internal hemangiomas, but again, it is very rare for this to be life-threatening, and when it is, this generally happens early in infancy when hemangiomas are growing.

5. Sometimes hemangiomas can scar. This is more likely to happen when a hemangioma ulcerates (see 1.), is large, red and very raised above the skin, or is in a certain location such as the tip of the nose or lip.

While most hemangiomas do not need treatment, some may for any of the above or other reasons. The most common treatments used for hemangiomas are wound care for ulceration, steroid medicine (creams, injections, or by mouth), laser or surgery. The decision whether to treat, and what to treat with, depends on many things including your child’s age, the size and location of the hemangioma, and the seriousness of the situation.