Hemangiomas in Children: Types, Symptoms, and Treatment

What Are Hemangiomas and Why Do They Occur?

Hemangiomas represent the most frequently encountered benign vascular tumors affecting infants and young children worldwide. These growths develop when blood vessel cells begin to multiply at an unusually accelerated rate, creating abnormal accumulations beneath or within the skin’s surface. The condition occurs due to endothelial cell proliferation, which is the abnormal multiplication of the cells that line blood vessels. While some hemangiomas are visible from the moment of birth, the majority emerge during the opening weeks and months of an infant’s life.

These benign tumors are remarkably common in the pediatric population. Approximately one-third of all hemangiomas are already present when a baby is born, while the remainder appear shortly thereafter. The development of hemangiomas involves complex biological processes that medical researchers continue to study, though the exact triggers remain not completely understood. What we do know is that these vascular anomalies are neither cancerous nor contagious, and they frequently resolve on their own without requiring intervention.

Distinguishing Between Different Hemangioma Categories

Medical professionals recognize two primary classifications of hemangiomas based on when they develop and how they behave over time. Understanding which type affects your child can help inform treatment decisions and expectations about progression.

Infantile Hemangiomas: The Most Common Presentation

Infantile hemangiomas represent the predominant form of this vascular condition. These birthmarks typically make their initial appearance between one to four weeks after birth, rather than being evident at delivery. Infantile hemangiomas follow a fairly predictable pattern of growth and involution. During the first year of life, these lesions tend to expand rapidly, often becoming noticeably larger and more prominent. Following this initial growth phase, the hemangioma gradually diminishes in size over the subsequent years, with many resolving completely or significantly improving by early childhood.

Congenital Hemangiomas: Present From Birth

Congenital hemangiomas develop while the baby is still in the womb and are observable immediately at birth. This category subdivides into two distinct types with very different outlooks. Rapidly involuting congenital hemangiomas (RICH) emerge during fetal development and tend to regress quickly during the infant’s first year, often shrinking substantially without medical intervention. Noninvoluting congenital hemangiomas (NICH), conversely, do not naturally diminish over time and typically require surgical removal if treatment is deemed necessary.

Identifying Hemangiomas by Their Physical Characteristics

The appearance of a hemangioma varies considerably depending on its location within the skin layers and the individual characteristics of the affected child. Learning to recognize these distinctive features helps parents identify potential concerns early.

Superficial Hemangiomas: Surface-Level Manifestations

Superficial hemangiomas occupy the uppermost layers of skin and present as bright red, raised lesions with poorly defined, bumpy borders. These are commonly termed “strawberry hemangiomas” because their appearance resembles the surface texture and color of a strawberry. They typically start as flat marks that gradually become elevated and more prominent. These lesions are located close enough to the skin surface that their bright coloration is immediately visible, making them the most easily noticeable type for parents and caregivers.

Deep Hemangiomas: Subcutaneous Growths

Deep hemangiomas develop beneath the skin surface within the subcutaneous fatty layers. Rather than displaying the bright red appearance of superficial lesions, deep hemangiomas appear bluish or purplish in hue. This color difference results from their deeper location under the skin, where wavelengths of light reflect differently through the overlying tissue. These hemangiomas often present as lumpy, raised swellings without well-defined borders. The depth of these lesions means they may not become apparent immediately, sometimes being discovered only when a parent notices unusual swelling or firmness beneath the skin.

Combined Hemangiomas: Mixed Presentations

Some children develop hemangiomas that span both the superficial and deep skin layers, displaying characteristics of both types. These mixed hemangiomas may show red discoloration in some areas with bluish swelling in others, depending on which layers are most extensively involved. The varied appearance reflects the complex vascular architecture underlying these growths.

Where Hemangiomas Typically Develop

Hemangiomas can emerge anywhere on the body, though certain locations are more frequently affected than others. Approximately 60 percent of hemangiomas occur in the head and neck region, making facial hemangiomas the most common presentation parents encounter. The trunk represents the second most common site, accounting for roughly 25 percent of cases, while extremities such as arms and legs are affected in approximately 15 percent of situations.

Recognizing Symptoms and When to Seek Evaluation

Most hemangiomas present no discomfort to the child and cause minimal physical disruption. However, understanding what constitutes normal hemangioma behavior versus warning signs requiring medical attention is crucial for parents.

Typical Characteristics of Uncomplicated Hemangiomas

Uncomplicated hemangiomas are generally painless lesions that feel soft to the touch. They typically appear as red to purplish marks flush with the skin surface or slightly raised above it. Some may develop from a stalk-like base extending outward from the skin. Most superficial hemangiomas cause no physical symptoms beyond their visible appearance.

Concerning Developments Requiring Medical Attention

Certain hemangioma characteristics warrant prompt evaluation by a healthcare specialist. These include:

• Hemangiomas located near the eyes that could interfere with vision development
• Lesions in the nasal area or involving ear structures that might distort normal development of these features
• Hemangiomas involving the airway or mouth region that could compromise breathing or eating
• Lesions in the genital area or on the lips that show signs of breakdown or ulceration
• Large facial hemangiomas spanning significant surface area, particularly if segmental in nature
• Any hemangioma displaying signs of infection, bleeding, or open sores

Potential Complications and Associated Conditions

While most hemangiomas resolve without significant problems, certain locations and characteristics can lead to complications affecting your child’s health and development.

Visual Development Concerns

Hemangiomas positioned near the eyes can interfere with normal vision development through several mechanisms. They may obstruct the visual axis, apply pressure that alters the eye’s shape, or interfere with tear production. These complications can lead to amblyopia (lazy eye), refractive errors, or other vision problems if not addressed promptly.

Structural Distortion

Hemangiomas affecting the nose and ears can cause permanent deformity of these structures as they grow. A particularly distinctive complication is the development of what specialists call “Cyrano nose,” where a hemangioma on the nasal tip causes permanent enlargement and distortion of the nose’s appearance. Similarly, hemangiomas of the ear can damage underlying cartilage and compromise normal ear development.

Ulceration and Bleeding

Ulceration, representing breakdown of the hemangioma surface into an open sore, represents the most common complication, occurring in up to 10 percent of cases. Hemangiomas on the lips, cheeks, neck, underarm region, and genital area carry the highest risk for ulceration. Ulcerated hemangiomas can bleed and typically leave permanent scarring even after healing.

Associated Syndromes

Large segmental facial hemangiomas, particularly those five centimeters or larger, may be associated with PHACES syndrome, which involves posterior fossa malformations, arterial anomalies, cardiac defects, eye abnormalities, and chest wall clefting. Additionally, lumbosacral hemangiomas can be associated with LUMBAR syndrome, involving underlying urogenital, spinal cord, and skeletal abnormalities that require specialized evaluation.

The Diagnostic Process

Diagnosis of hemangiomas typically begins with a physical examination by your child’s primary care physician. During this evaluation, the doctor will inspect the lesion’s appearance, feel its texture and firmness, determine its exact location, and assess whether surrounding tissue involvement exists. In most instances, visual examination provides sufficient information for diagnosis.

When hemangiomas develop in deep locations or when internal organs may be involved, more advanced imaging becomes necessary. CT scans and MRI studies can determine the extent of involvement and identify any associated anomalies. These imaging studies prove particularly valuable when planning treatment approaches or when syndromes like PHACES are suspected.

Treatment Approaches and Options

Treatment strategies for hemangiomas depend on several factors including the lesion’s size, location, whether it’s causing functional problems, and its growth pattern. Many hemangiomas require no treatment beyond monitoring, while others benefit from intervention to prevent complications or accelerate resolution.

Observation and Watchful Waiting

Because many infantile hemangiomas spontaneously resolve over time, observation represents a reasonable approach for lesions causing no functional impairment or cosmetic concern. Regular monitoring allows detection of any concerning developments requiring intervention.

Medical Management

Various medications can slow hemangioma growth or promote resolution, depending on the specific agent used and the hemangioma’s characteristics. Treatment options focus on limiting growth and promoting shrinkage of the vascular lesion.

Surgical Intervention

Surgical removal becomes appropriate for hemangiomas that don’t respond to medical therapy, those causing significant functional problems, or noninvoluting congenital hemangiomas that won’t resolve spontaneously. Surgical timing and technique depend on the specific hemangioma characteristics.

When to Contact Your Child’s Healthcare Provider

You should seek immediate medical attention if you notice the following concerning developments:

• Signs suggesting infection: increased redness, warmth, pus drainage, or fever
• Breakdown of the skin surface or formation of open sores
• Significant bleeding from the hemangioma
• Rapid growth that seems to accelerate unexpectedly
• Any hemangioma affecting the eye area, nose, ears, lips, or genital region
• Hemangiomas that impede normal feeding or breathing

Frequently Asked Questions About Childhood Hemangiomas

Q: Will my child’s hemangioma definitely go away on its own?

A: Many infantile hemangiomas do involute (shrink) spontaneously over years, but not all do. Congenital noninvoluting hemangiomas will not resolve without treatment. Your physician can provide specific predictions based on your child’s individual hemangioma type and characteristics.

Q: Is a hemangioma cancer or precancerous?

A: No. Hemangiomas are benign (non-cancerous) growths. They do not become cancerous and are not related to cancer development.

Q: Can hemangiomas be prevented?

A: Hemangiomas cannot be prevented, as their cause remains incompletely understood. They develop due to biological processes during fetal development or early infancy that are beyond parental control.

Q: Will treatment leave scars?

A: Treatment approaches vary in their scarring potential. Surgical removal may leave surgical scars, while medical treatments may avoid significant scarring. Your specialist can discuss expected outcomes for your child’s specific situation.

Q: How often should my child be evaluated?

A: Evaluation frequency depends on the hemangioma’s location, size, and behavior. Lesions requiring monitoring may need assessment every few weeks to months, while others may need less frequent follow-up. Your physician will establish an appropriate schedule.

Q: Can hemangiomas occur internally?

A: Yes, hemangiomas can occur in internal organs, though this is less common than skin hemangiomas. Symptoms vary depending on the organ involved, and imaging studies help identify internal lesions requiring specialized care.

Q: Is there a genetic component to hemangiomas?

A: While the exact causes remain unclear, hemangiomas don’t typically run in families as an inherited condition. They appear to result from sporadic developmental events rather than inherited genetic factors.