Hemangioma

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 26, 2016
StartDiseasesHemangioma

Hemangiomas appear when a collection of abnormal blood vessels form a noncancerous growth. Hemangiomas are generally present at birth although they may not be very visible at first. Most of the time a hemangioma starts as a tiny, red bump or a light, pinkish bruise, which is why these birthmarks are referred to as a strawberry mark

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Definition & Facts 

A hemangioma is a very specific type of vascular birthmark. It usually starts as a flat, red mark and starts to grow quickly to form a spongy bump that sticks out of the skin. During the first few weeks of life, a hemangioma will grow fast, until the baby is about 10 months. After this, the growth slows down and it reaches its shrunken state between the ages of five and seven, and it will not regrow. Most children born with a hemangioma will notice that by the time they are 10 years old, it is hardly visible. 

Hemangiomas develop on the surface of the skin; the scalp, chest, back, and face are the most common places they appear. They can also be found on internal organs; the liver is the most common organ to be affected.

The hemangioma may grow in the top layer of skin, known as a capillary hemangioma, or in the deeper layer of skin, known as a cavernous hemangioma. Sometimes they start in one layer of skin and spread to the next. The name hemangioma is often mistakenly applied to all vascular lesions. However, a hemangioma describes a particular type of vascular growth which is limited to newborns and children. 

Symptoms & Complaints

In the vast majority of cases, hemangiomas on the skin don’t cause any complication or pain, and they eventually shrink, leaving just a slight discoloration of the skin. Physical characteristics of hemangiomas include growths that appear as a raised sore or lesion on the skin or a raised tumor with blood vessels.

Sometimes a hemangioma can obstruct hearing, breathing, and vision. They can also become large, reddish-purple growths that distort facial features. When the growth breaks down, it can become infected and cause pain. In very rare cases, a hemangioma can cause internal bleeding and high-output heart failure.

Hemangiomas inside the body can grow on the kidneys, colon, brain, and lungs. If they are internal, they often go unnoticed, until they grow large. At which point, a hemangioma can cause discomfort. Some symptoms include:

Causes

Scientist do not know the exact reason blood vessels come together to form this growth, but they believe there may be a hereditary component involved. Research is ongoing to understand what activates its formation. At present, medical research doesn't indicate that there are activities, foods, or drugs that if undertaken or taken during pregnancy, can specifically trigger the development of a hemangioma. Nevertheless, certain populations are more at risk than others; hemangiomas more commonly appear in the following groups:

However, there are always exceptions, and it is possible for a second or third-born male baby delivered at full term to still be diagnosed with a hemangioma. 

Diagnosis & Tests

Tests are not necessary to diagnose a hemangioma. A doctor can make a more than 90 percent accurate diagnosis based on appearance and medical history. A child’s primary care physician will monitor the condition and growth rate of the hemangioma to ensure it goes through the normal process and shrinks down.

In cases where the hemangioma is big, growing fast, and becoming affected by an ulcer, the child should be diagnosed by a vascular anomalies specialist. If there are any questions about the kind of growth it is, further tests such as an MRI or ultrasonography can help to make a proper diagnosis.

If suspicion arises that the growth is cancerous, a biopsy is performed. When there are multiple hemangiomas on a child, it is necessary to have a pediatric specialist on vascular anomalies make a diagnosis. The presence of multiple hemangiomas could indicate that there is a hemangioma in an internal organ.

Treatment & Therapy 

In most cases, a hemangioma is harmless and doesn’t need to be treated as the course of the growth and the shrinking process follows a predictable path. Because a hemangioma naturally diminishes and never comes back, most doctors feel the side effects of treatment are not worth the risks. 

Still, complications that could arise due to the size and location of the hemangioma determine the best form of treatment. It may be possible that the hemangioma(s) interfere with the child’s ability to see, hear, eat or breathe. There are also cases where parents think that the mark may cause social problems and affect their child’s psychological development. In these cases, treatment could include:

  • Beta blocker drugs. Timolol can be applied to the affected area. In severe cases, an oral treatment of propranolol can be administered.
  • Corticosteroid medications. Corticosteroids are an alternative when a child can't use beta blockers. They can be given orally, by injection, or applied topically.
  • Surgical removal. The removal of hemangioma or the damaged part of the organ. 
  • Laser surgery. Sometimes the hemangioma can be removed with lasers. 

Some of these drugs and medications come with serious side effects that include high blood pressure, wheezing, high blood sugar, and stunted growth. Scientists continue to conduct research to discover treatments that are safer, and in the last five to seven years, new experimental medications are showing promise. While these medications are safer, doctors familiar with providing these types of medications should observe children during the entire treatment process. 

Prevention & Prophylaxis

There is no known way to prevent the occurrence of a hemangioma. More research is required to understand what triggers the blood vessels to group together in order to prevent one from forming in the first place.

Because hemangiomas mostly occur in premature babies, following the doctor’s advice on how to avoid a premature birth is the best way to help prevent a baby from being born with a hemangioma. This advice for pregnant mothers could include maintaining an adequate weight, eating a healthy diet, avoiding infections, going to prenatal classes, and avoiding alcohol use and drug use.