Hemangiomas, or strawberry birthmarks, are commonly seen in children, occurring in approximately 5-10% of 1-year-old infants. These marks are reddish, which is the result of blood vessel collection under the skin.
Despite being called strawberry birthmarks, hemangiomas do not necessarily appear at birth, as some children may not experience them until weeks after birth.
Typically, hemangiomas are small in size, but in some cases, they may grow very large, which naturally is quite worrisome for the parents.
However, you should know that these birthmarks are benign in nature, meaning you have no reason to worry, but it is still recommended by the American Academy of Pediatrics (AAP) to contact your baby’s pediatrician as soon as you notice strawberry-like structures on your child’s skin.
In this article, we will provide you with a comprehensive guide on how to identify infantile hemangiomas (I Hs), their causes, diagnosis, and available treatment options.
To identify strawberry birthmarks, you need to be familiar with where it might appear, as well as the types of hemangiomas there is.
As mentioned earlier, these benign tumors can appear anywhere in the body, with a special predilection towards certain areas, including:
When you notice a reddish area on your child’s skin, try to focus on the lesion; if you see superficial blood vessels accumulated together, it is probably a hemangioma.
Note that I said “probably” because of the resemblance of this lesion with several other dermatological conditions, such as port-wine stain.
Depending on the connection of hemangiomas with other tissues, we have three types:
Superficial hemangiomas
A superficial hemangioma is mostly composed of blood vessels near the outer layer of the skin (i.e. epidermis), which gives it a bright, red color and a relative elevation over the skin. In other words, if you touch the lesion, you will feel as if it’s a bump.
The exact causes of infantile hemangiomas are not yet identified; however, experts pinpointed common risk factors that may lead to this condition.
These include:
In most cases, the diagnosis of hemangiomas is straightforward.
When you suspect this condition and visit the pediatrician, he/she will take a look at the lesion during the physical examination to analyze its color, size, and depth.
If the doctor suspects that the strawberry birthmark extends into deeper layers of the skin, further testing might be warranted.
The most commonly ordered tests include CT scan, MRI, or a biopsy to study the cellular architecture of the tumor.
Finally, if the tumor is large enough and/or extending into deeper tissues, the doctor might recommend surgical excision, which requires brief hospitalization in a specialized surgical center.
The treatment options for hemangiomas are numerous due to how diverse these tumors are.
For instance, the doctor must take into account, the size, location, and invasiveness of the tumor, as well as the rate of growth before choosing the appropriate treatment approach.
Regardless of these considerations, here are the most commonly used treatments for hemangiomas:
If the tumor starts to grow in size or invade surrounding tissues, it might be time to consider other treatment options.
Beta-blockers are a class of medication used to treat blood hypertension, hyperthyroidism, and migraines. Since 2008, these drugs have become the number one prescribed treatment for hemangiomas. In infants who are 5 weeks of age or older, the FDA approved oral propranolol to treat IH.
Generally speaking, the treatment lasts for 6 months taking the drug twice a day. Additionally, your pediatrician might prescribe timolol (topical form) to apply on the site of hemangioma, which is a preferred choice for small tumors.
Both drugs proved their efficacy in slowing down the progression of hemangiomas and reducing the risk of complications.
Before approving beta-blockers as a treatment of IH by the FDA, corticosteroids were the gold standard therapy.
Physicians prescribe these drugs as monthly injections or topical use on the site of the hemangioma. However, due to the heavy side effect profile, most clinicians today favor propranolol, leaving cortisones to rare situations such as beta-blocker intolerance.
Phototherapy, or laser therapy, uses high-intensity beams of light to heal ulcerated hemangiomas. The mechanism of action involves the destruction and vasoconstriction (shrinking) of superficial vessels to stop the bleeding and ulcerations.
Physicians may order laser therapy to treat all different types of IH, especially those located in the airways, risking to compromise the child’s normal breathing.
The vast majority of IH do not require surgical interventions, but in some cases, the damage is too extensive to control with noninvasive treatments.
For instance, if the hemangioma damages the surrounding tissues, threat vital functions (e.g. breathing), or cause recurrent hemorrhages (bleeding), removing the tumor becomes inevitable.
This procedure requires general anesthesia and may lead to important scarring, which is one of the most important factors that physicians take into consideration when doing the benefit/risk analysis of the surgery.
Hemangioma in babies, or strawberry birthmark, are benign tumors that often cause great concern to parents, especially those who have never heard of this condition.
The pathophysiology and causes of this condition are poorly understood, but researchers are constantly conducting studies and clinical trials to better comprehend the underlying mechanism, as well as potential treatment approaches for hemangiomas.
Hopefully, you found this article helpful and informative, but if you still have any questions, feel free to ask in the comment section below.
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