Hemangioma of Infancy

Key points
Condition is benign, resulting in a proliferation of blood vessels and the cells that line them, which causes reddish or bluish lesions to appear on the skin. These can grow rapidly during the first year of life.
Condition develops after birth and can last months, then tends to disappear on its own over a period of years.
Cause has been linked to hypoxia in low birthweight or premature babies.

Infantile hemangioma, more commonly called strawberry birthmark, is a benign condition that affects the blood vessels through a proliferation of endothelial cells (the cells that line the blood vessels). Infantile hemangiomas are lesions that develops shortly after birth, not to be confused with vascular malformations which are present at birth. Most often, these hemangiomas occur on the head and neck area, growing over a period of months. Afterwards, they begin to regress, which can take upwards of ten years. Nearly all infantile hemangiomas eventually disappear without treatment. Some may be incomplete and leave scarring.

Infantile haemangiomas are classified as superficial, deep or mixed lesions. They may be confined to a small or larger area. Superficially they appear reddish, but deeper lesions will have a bluish tint and maybe some swelling. Ten percent of babies develop one or more haemangiomas. Hypoxia (inadequate oxygen to the skin) is now considered the likely reason for the proliferation of blood vessels. Normally, these cells and vessels have gone by the time a baby is born, but they may still be present in low birthweight or premature babies.

Differential Diagnosis (Other conditions with similar appearance)
Capillary Malformation
Cherry Hemangioma
Cobb Syndrome
Dabska Tumor
Oral Lymphangiomas
Vascular malformations

Diagnosis
Key Points
Infantile hemangiomas are usually diagnosed clinically.
More complicated or less traditional cases may require additional testing to prevent misdiagnosis, which can include ultrasound scanning, MRIs, or angiography.

Infantile hemangiomas are usually diagnosed clinically and no investigations are necessary for the majority of superficial lesions. Deep or segmental haemangiomas are routinely investigated with ultrasound scanning. An ultrasound scan is also often performed when there is uncertainty about the diagnosis or whether underlying tissues are affected. It may also be necessary to perform Magnetic Resonance Imaging (MRI) or angiography to help plan treatment. Hemangiomas arising over the lower part of the spine are sometimes a marker for spina bifida, when spinal imaging may be appropriate.

Treatment
Key Points
Treatment is usually unnecessary as most cases improve on their own over time.
Treatment should be considered if the lesions are causing other potential problems with basic sensory functions.
There are a number of possible treatments available in these dire cases.

Because infantile hemangiomas are likely to improve or regress completely with time, there is no need for specific treatment in most cases. Treatment should be considered if there are very large and unsightly lesions, ulcerations, impairment of sensory functions (vision, hearing, breathing, or feeding), or if they persist into school age.

Possible treatment includes external compression therapy (bandaging the limbs), ultrapotent Topical steroids, intralesional steroids, topical antiseptics, oral corticosteroids in high dose, propranolol, vascular laser therapy, interferon alpha (which may lead to cerebral palsy), vincristine, and Imiquimod. In recent studies, topical timolol has been efficacious.