An informational resource on hemangiomas created by pediatric dermatologists for parents and physicians.
Infantile hemangiomas are the most common skin growths of infancy. They are made up of small blood vessels (capillaries) and the cells that line them. Hemangioma are usually present at birth or develop within the first two months of life. They come in many shapes and sizes and can occur on many locations on the body.
The diagnosis of a hemangioma can usually be made by a doctor’s examination. Sometimes an ultrasound or MRI of the affected skin may be needed to further evaluate the lesion. Measurements and photographs of the lesion may be made at each office visit to help monitor the growth or improvement of the hemangioma.
Hemangiomas usually grow quickly in the young infant. The growth is usually most rapid in the first 3 to 6 months of life. Hemangiomas typically stop growing by 6 to 12 months of age. Most hemangiomas will gradually go away without treatment over time. While some hemangiomas are completely gone by 2-3 years of age, others may take 10-12 years to disappear. Even after the hemangioma has “gone away,” there may be some permanent changes in the affected areas of skin such as persistent redness or changes in the skin texture.
The most common complication of infantile hemangioma is ulceration (skin breakdown) which often occurs in specific locations on the body (diaper area, lips, scalp) and when hemangiomas are growing rapidly. Other complications may develop with certain high risk locations such as around the mouth or eyes.
Observation: Your child’s doctor will check the hemangioma at each visit and monitor for any problems or complications.
Oral propranolol: Your child will need very close monitoring while on this medication, including blood pressure and heart rate checks regularly. This medication is not given when your child is sick, not eating well, or having cough/wheeze/ or trouble breathing. This medication is usually reserved for infant hemangiomas that are at risk for medical or cosmetic complications.
Topical timolol 0.5% solution: This topical medication is applied to the hemangioma surface and requires close monitoring by your child’s doctor. This medication is usually used in problematic hemangiomas that are smaller and more superficial. It is not very effective for larger/deeper hemangiomas.
Oral steroids: Your child will need close monitoring while on this medication. This medication is usually used in infants that cannot be treated with propranolol or do not have an adequate response to propranolol.
Pulsed dye laser treatments: These treatments are mainly used for ulcerated hemangiomas and residual hemangiomas that have not faded completely. It may take several laser treatments to get the desired results. These treatments last only a few minutes each time and are scheduled 1-3 months apart. A topical anesthetic (numbing) cream can be applied before the scheduled treatment. This will make your child more comfortable during the treatment, although there may still be some mild discomfort. If your child requires laser treatment, more information will be provided to you.
Surgery: Rarely, surgical removal may be recommended for hemangiomas that are not going away as expected. This is usually considered in children at least 3-4 years of age or in the case of ulcerations that are not healing as expected.
Your child will need regular monitoring to re-evaluate the progress of the infantile hemangioma. It is very important to keep your child’s scheduled appointments.
Call your child’s doctor or the Dermatology nurse at (816) 960-4051, option 2 if:
Your child’s hemangioma becomes ulcerated (develops a sore/scab/skin breakdown).
The hemangioma is growing very rapidly prior to your scheduled appointment.
You have any questions or concerns about your child’s hemangioma or treatment.