Infantile hemangioma, also known as strawberry nevus or strawberry birthmarks, comprises extra blood vessels on the skin. This is a benign (noncancerous) tumor caused by abnormal blood vessels. Hemangiomas can vary in size, location, and appearance in each baby. This can be present at the time of birth or appear within a few weeks or months after birth and usually fades away by the age of five years in many children.
Although the appearance of hemangiomas can be worrisome, this may go away without complications and specific treatment in most babies. Large hemangiomas may require treatment to prevent permanent scars.
Read this post to know about the types, causes, signs, complications, and treatment of infantile hemangiomas.
Types Of Infantile Hemangiomas
Infantile hemangiomas can be of the following types (1).
- Superficial hemangiomas or capillary hemangiomas: It is also known as strawberry marks since the appearance may resemble a strawberry. These bright red, raised lesions usually begin as small pink, white, or red areas on the skin. Strawberry marks can be in one spot or over a large area.
- Deep hemangiomasorcavernous hemangiomas: This hemangioma forms under the skin, and the surface can be smooth. You may notice a bluish tint and swelling in the skin.
- Mixed hemangiomas: This is a combination of deep and superficial hemangiomas.
Causes Of Infantile Hemangiomas
The exact cause for infantile hemangioma is not known. It could occur due to the grouping of extra blood vessels for unknown reasons. Premature babies are more likely to get hemangiomas than term babies (2).
Some studies state that specific placental proteins in pregnancy may induce strawberry birthmark formation. However, this theory also lacks enough scientific evidence. Female gender and the presence of certain genes may be risk factors for developing strawberry marks.
Symptoms And Signs Of Infantile Hemangiomas
Hemangiomas may be present at birth or appear during the initial months of life. You may notice flat red or pink spots on the skin, and they may grow quickly into spongy bumps that stick out of the skin surface (3).
Strawberry birthmarks can occur anywhere on the body. However, it is more likely seen on the face, chest, scalp, and back of the body. Most babies may have a single strawberry nevus, while a few can have several of them.
Once the growth is finished, the hemangioma may stay in the same size or slowly begin to disappear by five to ten years of age. Hemangiomas may become less reddish and fade to grey or white when it starts to resolve. They may shrink or flatten from the center to the outside. Skin can be slightly discolored or raised even after the birthmark goes away.
Complications OfInfantile Hemangiomas
Hemangioma may break down and develop an open sore (ulcer) in some babies. This may cause the following complications (3).
- Permanent skin changes and distorted nose or facial part may occur in cases of large hemangiomas on the face
Hemangiomas may interfere with the body’s normal functions, depending on its location, and may cause the following complications.
- Vision problems, such as lazy eye (amblyopia) and glaucoma
- Hearing problems if located in the ear
- Breathing and eating difficulties are seen in larger hemangiomas located in the mouth
- Bowel movements can be affected if the nevus is located in the anal area
Although rare, vision loss may occur due to optic nerve atrophy if the hemangioma is located in the eye socket and presses the optic nerve.
Diagnosis OfInfantile Hemangiomas
Pediatricians can diagnose strawberry nevus on the skin by visual examination. Pediatricians may evaluate the size, number, and location of hemangiomas to plan treatment options. Referral to an ophthalmologist, pediatric dermatologist, or otorhinolaryngologist (ENT) is made depending on the site of hemangioma (4).
Specific tests are not necessary to diagnose strawberry birthmarks. Rarely, if the hemangiomas are located inside the body, imaging tests may be needed to monitor its growth.
Treatment For Infantile Hemangiomas
Treatment options may vary depending on the severity, size, and location of the strawberry birthmark. Although most of the hemangiomas on the skin may not require treatment, hemangiomas in the eye could need treatment to avoid vision problems.
The available treatments for strawberry birthmarks may include the following (5).
1. Systemic treatments
Systemic treatment involves the intake of oral or intravenous medications to control hemangiomas. Treatments may continue until the first year of life in some babies to avoid the recurrence. This may include:
- Oral steroids: This is a safe and effective oral medication for hemangiomas used in some babies.
- Propranolol: This is a beta-blocker medication that is prescribed for complicated hemangiomas. Oral intake is recommended, and the baby is observed for possible side effects since this may affect cardiac functions and blood pressure.
2. Localized treatments
Localized treatments are often prescribed for most babies. This may include:
- Steroid injection: This is the preferred treatment method for small and localized hemangiomas. The injection is given to the strawberry birthmark to reduce its growth.
- Topical medications: These medications are applied directly to superficial or capillary hemangioma Creams and ointment, including beta-blockers, are the best effective topical medications for strawberry nevus. This could cause the shrinking and fading of the birthmark.
- Steroid creams: Topical steroid creams are prescribed for thin and small hemangiomas.
All the systemic and localized medication for strawberry birthmarks require a medical prescription. It is not recommended to use over-the-counter medications to treat hemangiomas in babies.
3. Other treatments
Hemangiomas may also require procedures and surgeries other than medical treatments. This may include:
- Surgery: Small hemangiomas located on areas that may result in complications, such as vision problems, are surgically treated. Surgery may leave a scar or extra skin, and this is usually repaired when the baby is between three or five years of age.
- Laser treatment: This may reduce bleeding and enhance the healing of strawberry birthmarks with open sores. Skin color and texture changes are also treated with laser after the hemangioma goes away. This may also help to lighten the color of hemangioma and make it less visible.
These treatments are delayed in most babies with uncomplicated strawberry birthmarks since they may fade away without leaving any scars.
How to Cope When Other People Stare?
Some parents may face hard times dealing with others’ reactions to strawberry birthmarks on visible areas such as on the face, neck, arms, and ears. Although someone’s comment or stares at your baby can be difficult, you may try these tips to deal with such situations.
- Learn about hemangioma and its treatment options. It can help you better communicate about it to others.
- Explain that this is a condition that resolves over time if someone asks or suggests remedies to cure it.
- Understand that someone can be curious to know about the skin lesion and not trying to be rude to you.
- Smile or wave at people who stare unusually. This may make them embarrassed and takes their eyes off your baby.
- Say hello and take the opportunity to educate them about hemangiomas if they ask you about it.
- Ignore people who stare rudely at your baby. They have nothing to do with your life.
- Never let it get you. This is a normal condition that resolves over time. You should not avoid going out and having precious time with your baby to avoidothers’ questions or stares.
- Seek support from family, friends, or a support group if it disturbs you. Never spoil your emotional wellbeing for it.
You may also understand that the hemangioma resolves itself within a few years. Rushing to treatment options to avoid embarrassment or stare is not an ideal decision. You may seek pediatric consultation to know the requirement of treatment.
The American Academy of Pediatrics (AAP) recommends monitoring the hemangiomas until they go away since this may change quickly. According to the AAP, treatment can begin within the first month of life if required. Treatments are not recommended for uncomplicated cases since it resolves better without interventions, causing hemangioma to go away without any mark.
2. Infantile Hemangioma: Definition and Pathogenesis; DermNet NZ
3. Infantile Hemangioma; UCSF Benioff Children’s Hospitals
4. Diagnosis and Management of Infantile Hemangioma; The American Academy of Pediatrics
5. Infantile Hemangiomas: About Strawberry Birthmarks; Healthychildren; The American Academy of Pediatrics