Pediatric hemangioma
I wrote this article together with Dr. Rivka Friedland, an excellent pediatric dermatologist, who also wrote the important article about atopic dermatitis in infants.
What is hemangioma?
Hemangioma is a benign growth of blood vessels which is very common in babies and children. The pathology occurs in the inner lining of the blood vessels (called the endothelium).
The are several kinds of hemangioma. The most common one is infantile hemangioma, which occurs in about 5% of babies. This phenomenon is more common in girls, premature babies, twins and low birth weight babies.
Most infantile hemangioma appears at birth or within the first few days or weeks after birth, grow in size and thickness (or both) in the baby’s first year and undergo a regression that lasts a few years. After the regression, in half of the cases there is no trace left of the lesion and in the other half of the cases there may be a change in skin tone or texture.
What are the types of infantile hemangioma?
Superficial – has a bright red color, can be superficial or dull with clear borders and may appear anywhere on the skin (see image 1 and 2). Hemangiomas usually do not appear at birth but in some cases typical skin changes will appear in the area where the hemangioma will appear later. The area will sometimes appear brighter or a reddish spot will show or delicate blood vessels that don’t shine (telangiectasia). See images 3 and 4. The sign appears around birth and becomes a clearer finding at the age of 4 weeks.
Deep – Hemangioma which is located in a deeper layer of the skin and often causes a blueish bulge.
Mixed – has both superficial and deep components.
Visceral – has visceral involvement, for instance: hemangioma in the liver. brain, intestines and airways. This type is much less common, therefore this article will only refer to skin hemangioma since it is the most common type.
What are the common location of infantile hemangioma?
About 50% of hemangioma is found in the head of neck, mostly as a single lesion.
How is hemangioma diagnosed in children?
Skin hemangioma is usually very easily diagnosed based on its typical appearance. In some cases, an ultrasound test will confirm the diagnosis.
What is the common procedure in most infantile hemangioma?
As stated above, most hemangioma are not visible in birth but rather grow between the age of 4 weeks to a year. Most of the times there is rapid growth up to the age of 4 months and from then on up to the age of 12 months old, the growth is slower.
Usually between the age of 1-5 years old the growth stops and there is a spontaneous withdrawal and sometimes disappearance. In practice, the lesion becomes brighter, softer and its volume becomes smaller. In many cases the disappearance is followed by the center of the lesion booming pale.
About 60% of lesions will disappear up to the age of 5, and 90-95% up to the age of 9.
The is no correlation between the initial size and the location of the lesion to its probability to early disappearance.
What are the possible complications of hemangioma in children?
In most cases the natural course of hemangioma has no complications, the lesion is not painful or itchy, there is no danger for it to bleed and there is no tendency for the lesion to get injured.
Occasionally there may be:
1. Cosmetic disorder – mainly related to the location of the lesion. For example, hemangioma on the tip of the nose might cause damage to the structure of the nose.
2. Organ function disorder – for example, hemangioma on the eyelid can disturb eyesight or hemangioma in the breathing pipe area can cause congenital stridor.
3. Ulcer – on the hemangioma surface caused by friction or spontaneously. The appearance of an ulcer is usually accompanied by local pain and in most cases the healing will leave a scar.
What’s the treatment for infantile hemangioma?
The choice of treating hemangioma is from the Beta blocker medications family – Propranolol or Atenolol. This is a syrup given orally for children up to the age of 15 months.
In cases where the hemangioma is small and superficial, Propranolol gel can be used locally.
The choice of treatment and follow up should be given by a pediatric dermatologist.
In summary:
In summary, hemangioma is a very common topic in paediatric medicine which naturally rises many questions amongst parents. However, similar to many cases in pediatric medicine, here too in many cases there is no need in specific treatment.
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