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Did you know that (some) birthmarks are also called strawberry marks? For as long as I’ve been alive, I’ve considered strawberries to be very aesthetically pleasing fruits. Which is why I was slightly disappointed when I discovered that the only similarity ‘strawberry birthmarks’ physically have to the fruit is their bright red colour.
These marks are medically known as infantile hemangiomas and are pronounced as ‘hee-man-jee-oh-muh’s.They are non-cancerous tumours that are very common in newborns and manifest a few weeks (sometimes months) after birth.
An infantile hemangioma is a birthmark created by a collection of blood vessels developing in or beneath a baby’s skin. It commonly emerges in the first few days or months of life. The majority of these hemangiomas start out big and subsequently shrink over time.
Some may leave a mark or loosen the skin. They are known as “strawberry marks” because of their brilliant red hue, which resembles rubbery lumps or flat red patches.
Approximately 60% of them occur on the head or neck. Hemangiomas can develop on the face, scalp, chest, back, or elsewhere on the skin. About 30 percent are visible at birth as little red patches, while the others emerge between 2 weeks and 2 months old.
They develop fast for the first month and then continue to expand for another 5 or 6 months, a process known as proliferation.
About 80 percent of hemangiomas stop developing after about 5 months. Following this, they remain unchanged for a few months before gradually reducing, a process known as involution. By the age of ten, most hemangiomas are gone.
The normal evolution of infantile hemangioma consists of three phases:
Infantile hemangiomas (IH) are birthmarks that can be superficial, mixed, or deep, as well as those that grow slowly or not at all.
Infantile hemangiomas can also be classified based on their patterns:
Many parents incorrectly blame themselves for their baby’s hemangioma. While infantile hemangiomas can run in families, they are not caused by nutrition, genetics, environment, or parental conduct. It is made up of extra blood vessels that group together into a dense clump. The specific reason why the vessels clump remains unknown. However, some variables raise the risk.
Hemangiomas are more frequent in first-born children, preterm babies, and infants with low birth weight. They can, however, occur in full-term, normal-weight newborns of either gender or birth order. Doctors believe hemangiomas are linked to variations in oxygen levels during pregnancy.
A baby might not have any sign of a hemangioma at birth or might have a flat blue or red patch. It grows in the first few months and, in the first year, the red mark may grow into a spongy, rubbery lump, then stop growing and slowly start to go away. Shrinking can continue until the child is 7 or older.
Many hemangiomas disappear completely, but some leave discoloured or stretched skin. They usually appear often on the face, scalp, chest, or back. Most children have only one mark, but some have more.
Most hemangiomas are harmless but, sometimes complications arise.
Ulceration: Some hemangiomas can ulcerate, causing pain for babies. High-risk areas for ulceration include the lips, neck, diaper area, lower back, and armpits. Ulcerated hemangiomas leave scars, especially on the face, lip, nose, ear, cheek, forehead, and eyelid. Hemangiomas near the eye can affect vision. If a hemangioma is near the eye, see a paediatric ophthalmologist to ensure the baby’s vision is not compromised.
LUMBAR Syndrome: A large hemangioma on the lower back might indicate spinal cord issues. Even if a hemangioma appears harmless, those in high-risk areas should be evaluated by a doctor, as lumbar hemangiomas could be associated with LUMBAR syndrome, which involves lower body defects.
PHACE Syndrome: Large hemangiomas on the face, head, or neck might indicate PHACE syndrome, which involves defects in the brain, heart, and eyes. Patients with segmental hemangiomas in these areas have a higher risk of developing PHACE syndrome. PHACE stands for:
About 30% of those with segmental hemangiomas in the lower face have this syndrome. These patients should be evaluated with MRI or MRA of the head and neck, electrocardiography, and echocardiography to check for heart involvement.
Visceral hemangiomatosis: This condition is when hemangiomas are present in internal organs like the liver or gastrointestinal tract. It is more likely if a baby has five or more skin hemangiomas. When there are multiple skin lesions, doctors often check for internal hemangiomas, as these can cause complications with organ function. Early detection and management are important to address any potential issues.
Most infantile hemangiomas do not need treatment as they usually resolve on their own. However, complicated hemangiomas require treatment. Doctors treat hemangiomas that are very large, cause problems like bleeding or blocked vision, or affect appearance, especially those on the face. Treatments can be used alone or in combination.
Hemangioma treatment can involve injecting medication directly into the hemangioma, taking it orally, or receiving it through an injection through the veins (intravenous IV). Oral propranolol works well but can cause low blood pressure, breathing problems, and low blood sugar. Timolol in topical form (applied directly to the skin) is suitable for smaller hemangiomas and has fewer side effects.
The treatment choice depends on the hemangioma’s size, location, and severity, as well as the child’s health. Your healthcare provider will advise the best plan.
Both intralesional (injections) and topical (creams) corticosteroids work well for treating small hemangiomas. They reduce inflammation and shrink the lesions. Intralesional corticosteroids are injected into the hemangioma, while topical corticosteroids are applied directly to the skin. Oral prednisone is another choice.
But corticosteroids are only recommended if other medications are unavailable due to the severity of their side effects; irritability, sleep issues, high blood pressure, bone loss, heart issues, and slowed growth. However, their use should be monitored by a healthcare professional for potential side effects.
Surgical treatments for hemangiomas are used when they cause problems or don’t respond to other treatments. The best approach depends on the hemangioma’s size, location, and impact on the child’s health. Consulting a healthcare provider will help determine the right treatment. Options include:
It comes in two types. One aims to improve skin colour changes on the surface, and the other, called pulsed dye laser (PDL) treatment, targets small blood vessels near the hemangioma. However, PDL remains controversial for infantile hemangiomas that are deep. The choice of laser treatment depends on factors like how deep the hemangioma is, and specific skin changes, so consulting a specialist is recommended to find the best option.
Hemangioma treatment can involve injecting medication directly into the hemangioma, taking it orally, or receiving it through an injection through the veins (intravenous IV). Oral propranolol works well but can cause low blood pressure, breathing problems, and low blood sugar. Timolol in topical form (applied directly to the skin) is suitable for smaller hemangiomas and has fewer side effects.
The treatment choice depends on the hemangioma’s size, location, and severity, as well as the child’s health. Your healthcare provider will advise the best plan.
Both intralesional (injections) and topical (creams) corticosteroids work well for treating small hemangiomas. They reduce inflammation and shrink the lesions. Intralesional corticosteroids are injected into the hemangioma, while topical corticosteroids are applied directly to the skin. Oral prednisone is another choice.
But corticosteroids are only recommended if other medications are unavailable due to the severity of their side effects; irritability, sleep issues, high blood pressure, bone loss, heart issues, and slowed growth. However, their use should be monitored by a healthcare professional for potential side effects.
Surgical treatments for hemangiomas are used when they cause problems or don’t respond to other treatments. The best approach depends on the hemangioma’s size, location, and impact on the child’s health. Consulting a healthcare provider will help determine the right treatment. Options include:
It comes in two types. One aims to improve skin colour changes on the surface, and the other, called pulsed dye laser (PDL) treatment, targets small blood vessels near the hemangioma. However, PDL remains controversial for infantile hemangiomas that are deep. The choice of laser treatment depends on factors like how deep the hemangioma is, and specific skin changes, so consulting a specialist is recommended to find the best option.
If you note any changes in the size, colour, or texture of your child’s infantile hemangioma, or if they experience pain or bleeding from the affected area, it’s crucial to seek immediate medical attention.
These changes would indicate underlying complications or a need for an update on current treatment. Early evaluation by a healthcare professional ensures appropriate monitoring and intervention to address any emerging issues quickly.
Although most infantile hemangiomas naturally resolve themselves without causing significant problems, there is a possibility of long-term complications. In particular, hemangiomas located near the eyes may lead to scarring or vision impairment.
Additionally, while rare, they might be associated with other medical conditions that require further investigation and specialised care. Regular monitoring by healthcare providers is essential to detect and manage any potential complications effectively.
Although infantile hemangiomas usually do not cause pain or discomfort, they may become painful if they grow rapidly or ulcerate. In such cases, immediate evaluation by a healthcare provider is necessary to assess the situation and determine appropriate management strategies. Prompt intervention helps alleviate discomfort and prevent potential complications associated with painful or ulcerated hemangiomas.
In general, infantile hemangiomas don’t usually affect a child’s growth or development. However, larger ones or those causing complications may need treatment that could impact their well-being. Regular check-ups with a healthcare provider help monitor their growth and development.
Unfortunately, there aren’t any known ways to prevent infantile hemangiomas since their exact cause is still unclear. However, being aware of potential risk factors and seeking prompt medical evaluation if a hemangioma appears can help with timely management.
Although most infantile hemangiomas go away completely with or without treatment, there’s a chance they can come back, especially if treatment isn’t entirely effective or if the hemangioma wasn’t fully removed. Close monitoring and follow-up care help detect any recurrence early.
If you note any changes in the size, colour, or texture of your child’s infantile hemangioma, or if they experience pain or bleeding from the affected area, it’s crucial to seek immediate medical attention.
These changes would indicate underlying complications or a need for an update on current treatment. Early evaluation by a healthcare professional ensures appropriate monitoring and intervention to address any emerging issues quickly.
Although most infantile hemangiomas naturally resolve themselves without causing significant problems, there is a possibility of long-term complications. In particular, hemangiomas located near the eyes may lead to scarring or vision impairment.
Additionally, while rare, they might be associated with other medical conditions that require further investigation and specialised care. Regular monitoring by healthcare providers is essential to detect and manage any potential complications effectively.
Although infantile hemangiomas usually do not cause pain or discomfort, they may become painful if they grow rapidly or ulcerate. In such cases, immediate evaluation by a healthcare provider is necessary to assess the situation and determine appropriate management strategies. Prompt intervention helps alleviate discomfort and prevent potential complications associated with painful or ulcerated hemangiomas.
In general, infantile hemangiomas don’t usually affect a child’s growth or development. However, larger ones or those causing complications may need treatment that could impact their well-being. Regular check-ups with a healthcare provider help monitor their growth and development.
Unfortunately, there aren’t any known ways to prevent infantile hemangiomas since their exact cause is still unclear. However, being aware of potential risk factors and seeking prompt medical evaluation if a hemangioma appears can help with timely management.
Although most infantile hemangiomas go away completely with or without treatment, there’s a chance they can come back, especially if treatment isn’t entirely effective or if the hemangioma wasn’t fully removed. Close monitoring and follow-up care help detect any recurrence early.
1. Healthline. “Hemangioma of Skin: Outlook.” May, 2023.
2. KidsHealth. “Infantile Hemangioma.” November, 2022.
3. Mayo Clinic. “Hemangioma.” Mayo staff. June, 2023.
5. National Center for Biotechnology Information. “Infantile Hemangioma.” Amal Chamli, Payal Aggarwal, Radia Jamil et.al. June, 2023.
6. PubMed. Rodríguez Bandera AI, Sebaratnam DF, Wargon O et.al. Infantile hemangioma. “Part 1: Epidemiology, pathogenesis, clinical presentation and assessment”. 2021 Aug 19.
7. Royal Australian College of General Practitioners. “Infantile Haemangiomas.” Joseph Joseph, Tevi Wain. December, 2021.
8. Stanford Children’s Health. “Infantile Hemangioma.”
9. Yale Medicine. “Infantile Hemangioma.”
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