Infantile Haemangioma

What and how common are infantile haemangiomas?

• Infantile haemangiomas are collections of small blood vessels.
• They are most often found on the skin, but rarely, they may be found in other organs (e.g. liver).
• Although they can occur on any part of the skin, they most commonly occur on the head and neck region.
• They are relatively common and occur in one to two percent of babies. They occur more commonly in baby girls than boys, in premature babies and twins.

What do infantile haemangiomas look like and what happens to them as my baby grows?

• They can be “superficial” where they appear reddish, “deep” where they appear bluish, or “mixed” where they appear both bluish and reddish.
• Haemangiomas are usually not obvious at birth but become apparent after a few days or weeks of life.
• They grow rapidly in the first four to five months, then undergo a ‘rest period’ where the growth slows down or stops.
• After about one year of life, haemangiomas start to shrink and become lighter in colour. Haemangiomas eventually disappear at a rate of approximately ten percent per year.
• After it goes away, the skin may not be entirely normal. Possible residual skin changes occurring over the site of the haemangiomas include visible small blood vessels (telangiectasias), uneven skin texture and colour, and scarring.

Superficial infantile haemangioma	Mixed infantile haemangioma

What problems can occur with infantile haemangiomas?

• Haemangiomas around the eye may cause problems with the vision. Those around the mouth may cause feeding problems.
• Large haemangiomas along the jaw line (“beard” distribution) may be associated with involvement of the airways, leading to breathing problems.
• Large haemangiomas on the head and neck region may be associated with brain, eye or heart abnormalities (PHACES syndrome). Large haemangiomas on the groin region may be associated with genital or spinal problems (PELVIS syndrome). Your child’s doctor will discuss with you further tests to exclude these problems.
• Some larger haemangiomas, especially those in the groin region may bleed or ulcerate, causing pain, infection and scarring.
• Babies having five or more haemangiomas may have haemangiomas in the liver. They may also have thyroid abnormalities.

Your child’s doctor will discuss with you regarding further tests to exclude some of the above problems.

Do all infantile haemangiomas require treatment?

• Most haemangiomas do not require treatment.
• Factors that may determine if a haemangioma requires treatment include the size, site (e.g. eyelids, nose, lips) and potential for complications (e.g. ulceration, obstruction of the airway or visual field, interference with feeding, risk of permanent disfigurement).
• Infantile haemangiomas associated with other medical conditions (e.g. PHACES or PELVIS syndrome, liver haemangiomas) typically require treatment.

Your child’s doctor will determine if treatment is required.

What options are available for the treatment of haemangiomas?

• Beta-blockers
  o   Oral propranolol is the first-line treatment for haemangiomas that need medication. Treatment typically continues for at least 6 months and often until at least 12 months of age or longer.
  o   Topical timolol is a beta-blocker medication that is applied directly to the skin. It works best for small, thin, superficial infantile haemangiomas and is typically applied twice daily.
• Other medications such as systemic or intralesional corticosteroids and sirolimus may be used for haemangiomas that do not respond to propranolol or when propranolol cannot be used.
• Lasers (e.g. pulsed dye laser) may be used for treating residual redness or small blood vessels after the haemangioma has shrunk, or in ulcerated haemangiomas.
• Surgery is most used for treating residual skin changes (e.g. loose skin, scarring) or occasionally for small haemangiomas in certain location where early removal provides better cosmetic results.

The doctor will discuss with you the most appropriate form of treatment for your child’s infantile haemangioma(s).

When to seek medical attention:

• Rapid growth of the haemangioma
• Ulceration (broken skin) or bleeding
• Signs of infection (increased redness, warmth, pus, or fever)
• The haemangioma is near your child’s eye and seems to affect vision
• Difficulty breathing or noisy breathing (especially is the haemangioma is in the “beard area” of the face
• Five or more haemangiomas on the skin
• A large haemangioma on the face, lower back or diaper area
• Child appears to be in pain

The information above is also available for download in pdf format.