Hemangioma Symptoms & Causes

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In-Depth

Seeing a hemangioma on your baby’s skin can be scary, but most of these benign tumors go away on their own without any treatment.

So try not to worry. Hemangiomas are quite common. And if your baby does require treatment, the doctors at Children’s Hospital Boston are experts in the care and treatment of infantile hemangiomas.

How common are hemangiomas? 

Hemangiomas are the most common benign tumor in infants. Between four and ten percent of Caucasian infants are born with at least one hemangioma.

Hemangiomas are three to five times more common in females (especially fair-skinned girls) than in males, and occur more frequently in Caucasian infants than in Asian infants. They are rare in African-American infants. Premature infants are more likely to have hemangiomas.

Where do hemangiomas occur?

About 60 percent of hemangiomas occur in babies’ head and neck area. About 25 percent occur in the trunk and 15 percent occur in the arms or legs.

About 80 percent of hemangiomas grow as a single tumor, and about 20 percent occur in multiple areas.

While hemangiomas primarily grow within the skin, they do sometimes develop in an internal organ, including the liver and gastrointestinal tract.

Should we talk to a vascular anomalies specialist? 

Since most hemangiomas go away on their own without any treatment, the majority of children do not need to see a specialist in vascular anomalies. Your child’s pediatrician will monitor the lesion, provide support and reassurance, and contact a specialist if and when appropriate.

You should take your child to see a vascular anomalies specialist if any of the following conditions apply:

  • Your doctor isn’t sure about the diagnosis.
  • Your child’s hemangioma develops a scab.
  • Your child’s hemangioma is on her face.
  • The hemangioma is large, growing rapidly or in a spot (near the eye, for example) where it could cause complications.
  • Your child has multiple hemangiomas — this can be a sign that your child has a hemangioma in an internal organ, such as the liver or gastrointestinal tract, which could require treatment.
  • Your child has a hemangioma along the spine — this can be a sign that your child has a malformed spine.

Causes

What causes hemangiomas?

Researchers led by Joyce Bischoff, PhD, in Children's Vascular Biology Program, recently discovered that hemangiomas originate from stem cells. This discovery has led to more research into how we can use medications to stop the growth of tangled masses of blood vessels that make up a hemangioma.

Hemangiomas are not hereditary, and no known food, medication or activity during pregnancy can cause a hemangioma.

When do hemangiomas occur?

The average age when hemangioma appears is two weeks old. Sometimes your doctor will notice a hemangioma just after your baby is born while she’s still in the hospital.

Your doctor may not notice a deep hemangioma until your baby is three to four months old, because these hemangiomas don’t leave the typical red mark on your baby’s skin. They never develop in adults.

Signs and symptoms

What does a hemangioma look like?

There are a few different kinds and they have different appearances.

Superficial hemangioma: This most common type of hemangioma has a raised bright-red patch, sometimes with a textured surface. Usually, the last traces of color have faded by the time your child reaches age seven.

Deep hemangioma: These hemangiomas appear bruise-like or bluish in color. They’re often not diagnosed until swelling becomes apparent —when your child is around two to four months old.

Congenital hemangioma: These hemangiomas are large at birth and are purplish with prominent veins; they also may be encircled by a pale halo. There are two kinds of hemangiomas that are present at birth.

  • Non-involuting congenital hemangioma (NICH) — This kind of hemangioma appears fully formed and does not shrink over time like most other hemangiomas.
  • Rapidly involuting congenital hemangiomas (RICH) — This kind of hemangioma appears fully formed and then shrinks over the course of the first year of your baby’s life.

Complications

What are the possible complications of hemangiomas?

While most hemangiomas grow and shrink without causing your child much trouble, complications with hemangiomas can happen.

They include the common:

  • As the skin stretches around your child’s hemangioma, it can develop a wound and/or scab.

And the rare:

  • A hemangioma around your child’s eye or throat can cause problems with vital functions such as vision or breathing.
  • A large facial hemangioma can be disfiguring.
  • A hemangioma in an internal organ can cause internal bleeding or heart failure (this is exceedingly rare).

Long-term outlook

What is the long-term outlook for my child?

There are very few long-term risks of hemangiomas. Most hemangiomas go away on their own without any treatment.

If your child’s hemangioma does need treatment, our doctors can use a variety of methods to reduce the threat of further complications. For more information on treatment methods, see the Treatment & Care section.

About half of all hemangiomas will leave behind some extra skin, blood vessels and fatty tissue after they shrink. A doctor can help with these cosmetic issues, which you may want to address before your child begins school.

Can a hemangioma start growing again after it has shrunk?

No — once they’ve shrunk, hemangiomas never come back.

FAQ

Q: What is a hemangioma?
A:
It’s a benign (not cancerous) vascular tumor that grows quickly during the first few months of your child’s life and then slowly begins to shrink and fade when your child is about one year old.

Q: How common are hemangiomas?
A:
They’re pretty common. Between four and ten percent of Caucasian infants are born with at least one hemangioma.

Hemangiomas are three to five times more common in females (especially fair-skinned girls) than in males, and occur more frequently in Caucasian infants than in Asian infants. They are rare in African-American infants. Premature infants are more likely to have hemangiomas.

Q: What does a hemangioma look like?
A:
There are a few different kinds and they have different appearances.

Superficial hemangioma: Raised bright-red patch, sometimes with a textured surface. Usually, the last traces of color have faded by the time your child reaches age 7.

Deep hemangioma: Appear bruise-like or bluish in color. These types of hemangiomas often aren’t diagnosed until swelling becomes apparent —when your child is around 2 to 4 months old.

Congenital hemangioma: These are large at birth, round or oval and are purplish with prominent veins and may be encircled by a pale halo.

Q: What do we do about it?
A:
Most hemangiomas go away on their own without any treatment. We recommend that a primary care physician monitor your child’s lesion, provide support and reassurance and contact a vascular anomalies specialist if the situation warrants.

You should take your child to see a vascular anomalies specialist if any of the following conditions apply:

  • Your doctor isn’t sure about the diagnosis.
  • Your child’s hemangioma develops a scab.
  • Your child’s hemangioma is on the face.
  • Your child’s hemangioma is large, growing rapidly or in a spot (near the eye, for example) where it could cause complications.
  • Your child has multiple hemangiomas — this can be a sign that your child has a hemangioma in an internal organ, such as the liver or gastrointestinal tract, which could require treatment.
  • Your child has a hemangioma along the spine — this can be a sign that your child has a malformed spine.

Q: Will my child’s hemangioma require treatment?
A:
Not usually. Most hemangiomas grow and shrink on their own and don’t require formal treatment.

If your child’s hemangioma does require treatment, Children’s is home to the world’s largest Vascular Anomalies Center — which means we’ve got the expertise and experience to make sure your baby returns to good health as quickly as possible.

Q: What if my child’s hemangioma does need treatment?
A:
Our doctors use corticosteroids and other methods to slow the growth of the hemangioma and help to shrink it. For more information on treatment methods, see the Treatment & Care section.

Q: Can a hemangioma start growing again after it has shrunk?
A:
No — once they’ve shrunk, hemangiomas never come back.

Q: Will my child’s hemangioma completely go away?
A:
Not usually. While your child’s hemangioma will shrink, about half of these tumors leave behind excess skin, fat or blood vessels — there may also be some discoloration of the skin around the lesion.

Q: How long will it take to completely shrink?
A:
This varies, but most hemangiomas have finished shrinking by the time your child is between five and seven years old.

Q: What can we do about the excess skin, tissue and blood vessels?
A:
The excess skin and fat can be surgically removed. Pulsed-dye laser therapy effectively eliminates the extra blood vessels.

Q: What makes Children’s different?
A:
We’re home to the first and largest Vascular Anomalies Center in the world.

When doctors in other states or other countries need help diagnosing or treating children with vascular anomalies, including hemangiomas, they often come to us.

Questions to ask your doctor

It can be difficult to remember all the questions that you want to ask your child’s doctor at the appointment, and many parents find it helpful to jot them down. Here are some to get you started:

  • What kind of birthmark does my child have?
  • Could it be serious?
  • Is there anything we should watch for?
  • What treatments are available for removing the birthmark, if appropriate?
Stem cells suggest a better therapy for hemangiomas

Researchers in Children's Vascular Biology Program discovered that hemangiomas originate from stem cells. Steroids can interfere with these cells, blocking their ability to stimulate blood vessel growth. Bischoff's lab is now searching for other agents that could stop the proliferation of hemangioma stem cells and prevent them from forming unwanted blood vessels.

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- Sandra L. Fenwick, President and CEO

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