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Haemangiomas

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What are haemangiomas?

Haemangiomas are common growths made up of small blood vessels which appear in infancy, often in the first three weeks of life.

What do they look like and how do they grow?

1. Haemangiomas are usually known by their bright red strawberry-like appearance in early infancy. Although the "first sign" may be present at birth they more commonly appear just after birth. The "first sign" is a pale area, followed by small lines of dilated capillaries on which small raised red dots appear. These dots enlarge and join together to form a solid "red lump". This continues to grow for up to 20 weeks and then stops.
2. Sometimes in addition to the red superficial lump, a deeper or blue part develops underneath.
3. When the growing stage stops, at about 6 months of age, grey areas appear; this indicates a closure of blood vessels, which means the haemangioma will stop growing. Over the next 5 or 6 years the "red lump" gradually shrinks and may disappear completely. The deeper blue part is less likely to completely go away.

There are deeply placed haemangiomas which do not appear red, but are skin-coloured or bluish. At times deep and superficial haemangiomas are combined, producing a skin coloured or bluish lump with a bright red lump or patch on top of it.

What is the cause of haemangiomas?

The cause of haemangiomas is unknown. Premature babies have a greater tendency to develop small multiple haemangiomas. It is thought the oxygen premature babies need could cause haemangiomas, as oxygen is known to stimulate the growth of blood vessels.

There are some myths, especially among Mediterranean peoples, that these birthmarks are caused by the mother wishing for something red and then touching a part of her body, with the mark appearing in this area of the baby. There is no truth in this.

Do haemangiomas always disappear without a trace?

No: haemangiomas may break down on the surface or ulcerate. This occurs particularly in the fast growing stage. Some scarring always results if ulceration has occurred. Ulceration occurring at the "edge areas" such as lip, eyelid or the edge of the nose can cause serious scarring. Very large haemangiomas may leave a loose sac of tissue as they resolve. Sometimes large haemangiomas are replaced as they resolve by a fatty deposit leaving a residual lump.

Do haemangiomas bleed badly if they are injured?

Not usually: they are composed of very small dead-end vessels and major bleeding is unusual. If a deep ulceration occurs, sometimes a large blood vessel can be damaged causing severe bleeding.

Are there any more serious complications?

Yes: sometimes haemangiomas can threaten to block vital structures.

Eyes

A haemangioma closing the eye or even pressing on the eye in the early weeks of life can produce a permanent visual impairment.

Mouth

Large haemangiomas around the mouth may interfere with sucking.

Nose

Lesions blocking both nostrils can lead to breathing difficulties while the child is being fed.

Breathing passages

The breathing passages may be directly involved with the haemangioma. The possibility of this should be considered whenever there is a fast growing extensive lower face or neck haemangioma especially if there is also haemangioma inside the mouth. If a baby with a haemangioma in this area becomes hoarse urgent medical attention should be sought.

What is the treatment for haemangiomas?

Wait and watch: usually no treatment is required because they are usually uncomplicated and disappear slowly. Your doctor may be able to show you photographs of disappearing haemangiomas in other children to give you encouragement.

Cortisone

This is used in certain situations where complications could happen. Cortisone medicine is given to slow the growth and prevent the haemangioma from growing to full size. This treatment is rarely useful after the haemangioma is fully grown (usually at 20 weeks). The earlier cortisone is used the better the outcome. Doctors try to pick which haemangiomas could lead to serious scarring if they ulcerated (remember ulceration is most likely when the growth is fastest), or which could lead to serious obstruction and start cortisone treatment to prevent these complications. The use of high doses of cortisone in young children is best managed by a paediatric specialist.

Specialised dressings

A range of new dressings are now available which help heal ulcerated haemangiomas.

Surgery

This may be required to deal with a loose sac of tissue or a fatty deposit that remains.

Laser

Lasers have very little place in the management of haemangiomas. They are used mainly for port wine stains which are another type of blood vessel birthmark. Occasionally they are useful in speeding the healing of a very bad ulcer.

Conclusion

In most cases haemangiomas are uncomplicated and go away. It is often difficult for parents to cope with the look of a haemangioma as they view it as a disfigurement. Reassurance and counselling of parents towards acceptance of the condition is necessary. The appearance is usually much improved by the time the child is old enough to be really aware of it.

Some haemangiomas are potentially very serious or can lead to results that are far from perfect. Seek specialist attention if you feel that your baby's haemangioma is a potentially troublesome or dangerous one.

• The cause of haemangiomas is unknown.
• In most cases haemangiomas are uncomplicated and go away.
• However, if your baby's haemangioma is growing rapidly, is forming an ulcer, is on the lip, near the eye or on the tip of the nose - or if your baby is having difficulty breathing - please seek immediate medical attention.

The Children's Hospital at Westmead Tel: (02) 9845 3585 Fax: (02) 9845 3562 http://www.chw.edu.au/	Sydney Children's Hospital, Randwick Tel: (02) 9382 1688 Fax: (02) 9382 1451 http://www.sch.edu.au/