Haemangiomas (he-man-gee-omas) are a common type of birthmark that are usually red or purple. They are sometimes called strawberry naevus because of their bright, red strawberry colour. Haemangiomas can occur anywhere (often on the head and neck areas) and develop shortly after birth. Haemangiomas are caused by an overgrowth of the cells that line blood vessels (arteries and veins).
One in 15 babies will develop a haemangioma. Some children can have more than one haemangioma. Younger siblings will not have an increased risk of having a similar birthmark.
Haemangiomas usually don’t cause any problems, and will often shrink away over a few years even if they are not treated. However, sometimes they cause problems including ulceration, scarring, blindness and disfigurement. Therefore some haemangiomas require treatment, which may be
medicine, laser treatment or surgery.
Signs and symptoms of haemangiomas
Haemangiomas usually appear in early infancy. They are often confused with a scratch or bruising related to birth trauma. They then become a flat, red patch, often with blood vessels you can see.
- If they are on the skin surface, they can look like a strawberry.
- If they are deeper in the skin, they look like a bluish lump.
- Sometimes they have both a surface and a deep part.
Haemangiomas can also grow in internal organs. These behave in the same way as those on the skin, and are usually not a problem.
Haemangiomas grow fast in the first few months, which can be alarming, but they then usually stop. Only occasionally do they keep growing after the child is 12 months old.
Once they have stopped growing, haemangiomas start to shrink and fade. Some will go away completely, while others will leave behind an area of loose skin. The time they take to disappear can vary. Some will have nearly gone by three years of age, while a small number (less than one in 10) are
still there when the child is eight or nine years old.
Other types of birthmarks
Congenital haemangiomas are a separate type of haemangioma, which are fully formed at birth. Some stay the same size for many years and others go away over the first few months of life.
Another much rarer type of birthmark called a vascular malformation is sometimes confused with haemangioma. These do not go away but grow with the child. They are true birthmarks that remain throughout a person's life.
When to see a doctor
If your child develops a haemangioma, always show it to your GP or paediatrician.
Haemangiomas located around the mouth, nose, eyes or bottom (the anal and genital region) should be assessed by a health professional experienced with managing haemangiomas.
Sometimes the skin surface can ulcerate (develop a sore). When this happens, haemangiomas can become painful and can bleed, particularly if knocked or infected. This is most common when haemangiomas are located in areas where there is pressure on the skin (e.g. the nappy area).
- If the haemangioma bleeds, put firm pressure on the area for 10 minutes, or until the bleeding stops, and tell your doctor about the bleeding. Take your child to a GP or go to your nearest emergency department if you cannot stop the bleeding.
- See a dermatologist or paediatrician if your child has a ulcer on their haemangioma that is very painful. Your child may be prescribed a local anaesthetic cream to help reduce their pain, and/or an antibiotic cream for infection. Once you have put the cream on the ulcer, you will need to cover
the ulcer with a dressing. Haemangiomas that are ulcerated can be quite slow to heal.
Specialist assessment is needed for children who have large haemangiomas (larger than 3 cm) and babies with more than five haemangiomas. Very rarely, children with a large haemangioma may have other problems including brain, eye and heart problems.
Treatment for haemangiomas
Most haemangiomas disappear by themselves and do not need any treatment. A haemangioma will need treatment if:
- it is pressing on an important structure, such as the eyes, nose, ears or windpipe
- it is on your child's eyelid or if it is large and on your child's face – these haemangiomas need urgent treatment to prevent serious problems, such as blindness
- it bleeds or becomes ulcerated, painful and does not heal
- its appearance is causing problems for your child’s self-esteem and social development when they reach school age.
Treatment should be given when the benefits of treatment outweigh the risks involved. All treatments have side effects that your doctor will discuss with you.
Oral medication
When treatment is required, an oral medicine is sometimes used (propranolol or atenolol). This aims to stop the growth and encourage shrinkage of the haemangioma. Every medication has side effects, and you should discuss these with your child's doctor.
Topical medication
Treatment with a topical medicine (timolol) can sometimes help treat haemangiomas, if used early on when the haemangioma is still small and flat. This aims to stop the growth and encourage shrinkage of the haemangioma.
Laser therapy
Laser treatment can sometimes help treat a haemangioma, especially if used very early in life while the haemangioma is still flat. The laser destroys the blood vessels that make up the birthmark without injuring the skin over the top. Laser is sometimes used for cosmetic reasons if a small
pink patch remains after the haemangioma has shrunk down.
Surgery
In a few cases, haemangiomas are removed by surgery during the first year of life. However, it is more common for surgery to be delayed for several years until the haemangioma has shrunk naturally.
When your child's haemangioma has mostly disappeared, there may still be some scarring or loose skin. These might need surgery at a later time.
Key points to remember
- Haemangiomas usually go away by themselves without any treatment, but some types will need treatment based on their size, location or complication.
- Haemangiomas grow before they go away. This growth can be alarming but it does stop.
- Haemangiomas can cause problems either by pressing on body parts, or by affecting your child's self-esteem and social development.
- Haemangiomas that are on or very near the eye, nose or mouth should be assessed by a specialist.
- If your child’s haemangioma forms an ulcer or won’t stop bleeding, seek medical assistance.
For more information
Common questions our doctors are asked
What are the possible side effects of haemangioma
treatments?
The oral medicine used to treat haemangiomas has effects on
blood sugar and the cardiovascular system. Although the doses used are very
low, it is important that your child is assessed by their doctor during
therapy. For surgery or laser treatments, scars can remain. There are also
possible side effects from the anaesthetic/sedation used for the surgery, but
you can discuss this with your child's doctor.
Are haemangiomas and port wine stains the same thing?
No – port wine stains
(the medical term is capillary malformations) are a permanent birthmark,
whereas haemangiomas have a predictable course of growth then resolution, and
they eventually disappear.
Developed by The Royal Children's Hospital Dermatology, Plastic Surgery, General Surgery and General Medicine departments. We acknowledge the input of RCH consumers and carers.
Reviewed December 2023.
This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.
Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit
www.rchfoundation.org.au.