Infantile Hemangioma in Children: Causes, Symptoms and Treatment

Infantile hemangioma is one of the most common benign vascular tumors in infancy, primarily affecting the skin. Often referred to as a “strawberry mark,” it can appear within the first few weeks of life and typically undergoes a rapid growth phase followed by a gradual involution. While most hemangiomas are harmless and resolve on their own, some may require medical intervention due to location, size, or complications such as ulceration or interference with vital functions.

What is Infantile Hemangioma?

Infantile hemangiomas are non-cancerous tumors composed of blood vessels. These growths usually appear in the skin, but they can also occur in deeper tissues such as muscles, bones, or internal organs like the liver. They are characterized by an initial proliferative phase, during which they grow rapidly, followed by a slow involution phase where they shrink and may disappear entirely.

While they are generally not dangerous, their size and location can occasionally lead to complications. For instance, hemangiomas around the eyes can impair vision, while those near the airway may interfere with breathing. Understanding the causes, symptoms, and treatment options is essential for parents and caregivers.

Causes of Infantile Hemangioma

Genetic and Environmental Factors

The exact cause of infantile hemangioma is still under investigation, but several factors are believed to contribute. These include genetic predisposition and environmental influences. Some studies suggest that hemangiomas result from disorganized blood vessel development during fetal growth.

Risk Factors

• Prematurity: Babies born prematurely are at a higher risk.
• Low birth weight: Infants weighing less than 2.5 kg have increased incidence.
• Female gender: Girls are more likely to develop infantile hemangiomas than boys.
• Multiple births: Twins or triplets are more prone.
• Caucasian ethnicity: Higher incidence is noted in white infants compared to other ethnicities.

These risk factors suggest a complex interplay of genetic and vascular development components.

Symptoms of Infantile Hemangioma

Appearance and Growth Pattern

Hemangiomas typically appear as a bright red or bluish lump on the skin. They usually emerge within the first few weeks after birth. The growth phase lasts for several months, usually up to a year, and is followed by a slow regression phase that can span years.

Location-Based Symptoms

• Facial hemangiomas: May lead to cosmetic concerns or affect vision and hearing.
• Neck or airway hemangiomas: Can cause breathing difficulties.
• Perineal or genital area: Risk of ulceration and infection.
• Internal hemangiomas: May not be visible but can be detected through imaging if symptoms arise.

Complications

• Ulceration: Open sores can develop, especially in areas prone to friction.
• Bleeding: Though rare, hemangiomas can bleed if injured.
• Infection: Ulcerated hemangiomas can become infected.
• Functional impairment: Depending on the location, they can hinder vision, breathing, or movement.

Diagnosis of Infantile Hemangioma

Clinical Evaluation

Doctors usually diagnose infantile hemangioma through physical examination. The typical appearance and behavior of the lesion often provide enough information for a clinical diagnosis.

Imaging and Tests

• Ultrasound: Used to assess the depth and blood flow.
• MRI: For detailed imaging of deep or large hemangiomas.
• Biopsy: Rarely needed but may be done in atypical cases.

Treatment of Infantile Hemangioma

Watchful Waiting

Most infantile hemangiomas in children do not require treatment and resolve spontaneously. Regular monitoring is advised to observe the growth and regression phases.

Medical Therapy

• Oral Propranolol: A beta-blocker that is the first-line treatment for problematic hemangiomas. It helps reduce size and color.
• Topical Timolol: Suitable for smaller, superficial hemangiomas.
• Corticosteroids: Occasionally used when beta-blockers are ineffective or contraindicated.

Surgical and Laser Interventions

• Laser therapy: Used for superficial hemangiomas or residual redness.
• Surgical removal: Considered for residual lesions or complications after involution.

Multidisciplinary Approach

Severe or complicated hemangiomas often require a team of specialists, including dermatologists, pediatricians, surgeons, and ENT specialists, to formulate the best treatment plan.

Prognosis

Most infantile hemangiomas in children resolve by the age of 5–10 years with little to no residual effect. However, timely treatment for complicated cases ensures better functional and cosmetic outcomes.

Table: Quick Overview of Infantile Hemangioma

Frequently Asked Questions

What is the main cause of infantile hemangioma in children?

While the exact cause of infantile hemangioma in children is still unknown, it is believed to stem from abnormal development of blood vessels during fetal life. Factors like premature birth, low birth weight, female gender, and genetic predisposition increase the risk. Some researchers propose that localized tissue hypoxia (low oxygen) during fetal development may trigger abnormal blood vessel formation. It is also thought that certain placenta-derived cells contribute to the formation of these lesions. However, it is important to remember that these growths are benign and typically not caused by anything the parents did or didn’t do during pregnancy.

Can infantile hemangiomas become cancerous?

No, infantile hemangiomas are non-cancerous (benign). They do not turn into cancer and do not spread to other parts of the body like malignant tumors. However, in rare cases, complications such as ulceration or interference with vital functions may necessitate medical treatment. Parents should not worry about these tumors becoming cancer, but they should monitor for any rapid growth or signs of complication and consult a pediatric specialist if concerned.

When should parents seek medical treatment for a hemangioma?

Medical treatment is advised if a hemangioma is growing rapidly, is located near vital areas like the eyes, nose, mouth, or genitals, or shows signs of complications like ulceration or bleeding. If the lesion interferes with normal functioning (e.g., breathing or feeding), prompt intervention is crucial. Additionally, hemangiomas that show no sign of slowing down after the typical growth phase may need evaluation for medical therapy like oral propranolol. Early consultation ensures better cosmetic and functional outcomes.

How is infantile hemangioma treated in babies?

Treatment varies based on the size, depth, and location of the hemangioma. The mainstay of treatment is oral propranolol, which effectively shrinks the lesion in many cases. Topical timolol may be used for smaller, superficial hemangiomas. In some cases, laser therapy or surgery is recommended, especially for residual tissue after involution or for complications. The decision is made by a team of specialists depending on the case complexity.

Is infantile hemangioma painful for children?

Typically, infantile hemangiomas are not painful, especially in the early stages. However, if the lesion ulcerates or becomes infected, it can cause significant pain and discomfort. Parents should look for signs like scabbing, bleeding, or the child crying when the area is touched. Painful hemangiomas must be evaluated and treated appropriately to prevent further complications.

Can hemangiomas recur after treatment?

In most cases, hemangiomas do not recur after involution or successful treatment. However, some children may retain residual skin changes like excess skin or minor scarring, especially if the lesion was large or ulcerated. Surgical removal may be an option in such cases, though recurrence of the vascular component itself is very rare.

How long does it take for infantile hemangiomas to disappear?

The timeline for regression varies, but most infantile hemangiomas start shrinking after the first year and continue to regress over 3–10 years. By school age, most children have minimal to no visible traces. In some cases, minor residual redness or loose skin may remain, which can be corrected if necessary. Patience is key, as the involution process is gradual.

Do infantile hemangiomas require lifelong monitoring?

No, lifelong monitoring is not required for most cases. Once a hemangioma has regressed, it usually does not pose any further concern. Monitoring is only necessary during the growth and regression phases. If a hemangioma causes complications or cosmetic concerns, a pediatric dermatologist or plastic surgeon may provide follow-up care as needed.

Can infantile hemangioma affect internal organs?

Yes, though rare, hemangiomas can occur internally, particularly in the liver or gastrointestinal tract. Internal hemangiomas are typically diagnosed through imaging studies if the child presents with symptoms like unexplained abdominal swelling or gastrointestinal bleeding. These require specialized care and are monitored closely depending on their location and size.

Is it safe to use beta-blockers like propranolol in infants?

Yes, oral propranolol has been extensively studied and is considered safe when administered under medical supervision. It is the first-line treatment for problematic hemangiomas and has shown excellent outcomes. However, infants on propranolol require monitoring for side effects such as low blood pressure, low heart rate, or low blood sugar. The treatment is typically well tolerated when prescribed by an experienced pediatrician.

Research Articles on Infantile Hemangioma