Hemangiomas
Hemangiomas are collections of extra blood vessels in the skin and are one of the most common skin problems in the first year of life. Although only 1 to 2.6 percent of newborn infants have hemangiomas present at birth, the lesions are found in up to 10 percent of patients by 1 year of age, and appear most frequently during the first one to four weeks of life.
What do they look like?
Hemangiomas may have different appearances, depending upon the depth of the increased numbers of blood vessels. More superficial hemangiomas tend to be bright red and elevated with an uneven surface. Deeper hemangiomas tend to be smooth on the surface, but bluish in coloration. Many times, both red and blue components will be present. Not infrequently, the more superficial types of hemangiomas begin as flat, pink areas, but rapidly change into the elevated, bright red lesions.
Do they ever change or go away by themselves?
Hemangiomas typically tend to enlarge in size when the infant is between one month and approximately eight months of age. Then they often reach a plateau and begin to resolve most extensively when the child is between one and three years of age. Approximately 50 percent of hemangiomas are gone by the time the child reaches five years of age; more than 90 percent are totally gone by age nine. Occasionally, resolution can take up to as long as 12 years. In up to 50 percent of hemangiomas, some slight to more extensive skin changes may be noted when "clear." These changes include whiter skin, puckering, scarring, and persistent visible blood vessels.
What can be done?
Because of the natural history of eventual resolution of these lesions and the potential side effects of available treatment agents, we rarely intervene with aggressive therapy. Exceptions include situations of severe ulceration or disfigurement, and problems with vital functioning, including eating effectively, vision, hearing and breathing. A few other rare situations also require immediate intervention.
The most common means of intervention are systemic (medications by mouth) or intra-lesional (injected directly into the lesion) corticosteroids, surgery and laser treatment. The choice to use one of these various techniques depends on the location, age of the child, and size and appearance of the lesion. Children with hemangiomas that cause problems must be followed carefully. Otherwise, typically the most appropriate care is simply having your doctor observe the changing lesion at intervals.
We certainly encourage you to feel good about the probability of resolution of your child's hemangioma. It is very important that the child be treated as a normal child, and that frequent pictures are taken of the child as he or she develops.