Haemangioma of Infancy
Haemangioma of Infancy is a benign overgrowth of blood vessel cells in the skin.
They are proliferative lesions which usually appear on the skin shortly after birth, and can grow for up to 18 months, although they usually stop growing at around 5 months.
The condition can be localised or segmental.
Localised haemangioma affects a small area, and can be superficial (also known as capillary haemangioma, capillary naevus, strawberry haemangioma, strawberry naevus, and haemangioma simplex), which affects the pigment on the top layer of the skin, or it can be deep (also known as cavernous haemangiomas) where the condition is deeply set in the dermis and subcutis.
Segmental haemangioma appear at a younger age and can grow up to 10 times larger. This means that they are generally more noticeable and may appear unsightly. They are more serious as they can affect deeper tissue.
What causes Haemangioma of Infancy?
The exact cause is not known. It may be that an inadequate amount of oxygen reaching the skin is considered to be the most likely reason for proliferation of blood vessels (also known as hypoxia.).
This causes the endothelial progenitor cells (EPCs) to circulate in the foetus, and form new blood vessels which have usually disappeared by the time the baby is born. If the baby is premature, or has low birth rate, these EPCs are still present.
It is thought that segmental haemangiomas arise within 6-8 weeks of pregnancy.
Who is at risk of Haemangioma of Infancy?
The localised form of the condition is thought to affect around 4-6% of all children, and is more common in girls, in triplets or twin pregnancies and in children who are premature.
What are the symptoms of Haemangioma of Infancy?
The condition usually begins as a small red mark shortly after birth. This grows larger and spreads over a period of 5-6 months, after which they usually stop growing, and begin to shrink (involution). In some instances they may keep growing up to 18 months. However, the shrinking can take 3-10 years before the mark has disappeared completely.
The haemangiomas will usually appear red in colour, but may have a deeper blue component which looks like swelling under the skin.
In most cases the condition affects the face, head and neck, but any part of the skin can be affected.
Often the haemangiomas leave no visible mark once they have shrunk, but there can be some paleness, loose or baggy skin, scarring or residual blood vessels visible.
Images of Haemangioma of Infancy
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How does a Dermatologist diagnose Haemangioma of Infancy?
A Dermatologist diagnoses the condition through a physical examination. In rare cases a biopsy may be required.
Whilst the localised form of the condition will usually need no further investigation, the segmented form of the condition may need further diagnostic tests to check for tissue damage, to help plan treatment, or check for other possible associated conditions. Tests required may include blood tests, blood pressure check and perhaps a scan of the heart.
How does a Dermatologist treat Haemangioma of Infancy?
A dermatologist will tend not to treat simple uncomplicated haemangioma as the condition improves and disappears with time. However, if the lesions are very large, do not disappear by the time the child reaches school age, are ulcerated then treatment may be needed. Haemangioma’s around the eye areas should be assessed by a Dermatologist as soon as possible as if left untreated they can result in impaired vision. Other areas of concern are the tip of the nose which can lead to significant cosmetic problems, and haemangioma around the lower lip and the beard area which can signify problems with the airway.
The first line of treatment for problematic haemangioma is Propranolol which is a medication from the class of beta blockers, which is thought to inhibit the growth of blood vessels. Topical beta blockers, such as Timolol, available as eye drops or gel, is also used for small superficial haemangiomas. Oral or intravenous steroid treatments may also be prescribed but can come with side effects.
Ulcerating haemangioma may need additional pain relief treatment, antibiotics for possible infection, or non- adherent dressing.
If the haemangioma remains and is no longer decreasing in size, laser treatment may be advised to remove the lesions when the child is much older.
Skin surgery may be considered to treat ulceration, obstruction or residual skin issues caused by a haemangioma where it causes a significant cosmetic problem, although Dermatologists will tend to avoid surgery until the child is much older.
Cosmetic camouflage, using specially designed waterproof make up, may also be useful to disguise skin discolouration or scarring.