What is an infantile hemangioma?

From the Guidelines

An infantile hemangioma is a common, benign vascular tumor that appears in early infancy as a bright red or bluish mark on the skin, typically developing within the first few weeks after birth and growing rapidly during the first year of life before gradually shrinking and fading over several years in a process called involution. These growths are made up of an abnormal collection of blood vessels and can occur anywhere on the body, though they're most common on the face, scalp, chest, and back 1. Most infantile hemangiomas don't require treatment as they resolve on their own, but treatment may be recommended if the hemangioma interferes with vision, breathing, or feeding, causes skin breakdown, or leads to significant disfigurement.

Some key characteristics of infantile hemangiomas include:

• They occur in as many as 5% of infants, making them the most common benign tumor of infancy 1
• They are more common in premature or low-birthweight infants, females, and white people 1
• Placental anomalies are an important risk factor 1
• The most rapid and significant growth occurs between 1 and 3 months of age, and growth is completed by 5 months of age in most cases 1

When treatment is needed, options include:

• Oral propranolol, which is the drug of choice at a dose of 2 to 3 mg/kg per day 1
• Topical timolol, which may be used to treat select small, thin, superficial IHs 1
• Surgery and/or laser treatment, which are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs 1

Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. Parents should monitor the hemangioma for changes in size, color, or texture, and watch for signs of ulceration or bleeding. The exact cause of infantile hemangiomas isn't fully understood, but they may result from placental cells entering the baby's developing tissues during pregnancy or from localized hypoxia triggering blood vessel formation.

From the Research

Definition and Characteristics of Infantile Hemangioma

• Infantile hemangioma (IH) is the most common benign vascular tumor of infancy, affecting about 5% of infants 2.
• It is characterized by a growth pattern of early rapid proliferation followed by progressive involution 2, 3.
• IHs are vascular growths characterized by an abnormal proliferation of endothelial cells and aberrant blood vessel architecture 4.
• They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches, and then grow rapidly in the first 3 to 6 months of life 3.

Clinical Manifestations and Diagnosis

• Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated, while deep lesions are bluish and dome-shaped 3.
• Diagnosis is usually clinical, and propranolol is currently the mainstay of treatment 5.
• The majority of infantile hemangiomas are not present at birth and continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child 3.

Treatment and Management

• The majority of infantile hemangiomas require no treatment, but treatment options include oral propranolol, topical timolol, and oral corticosteroids 2, 3.
• Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration, interference with vital structures, life- or function-threatening complications, and significant disfigurement 3.
• Early initiation of treatment with propranolol, especially before 3 months of age, results in significantly higher aesthetic and functional improvement rates and a higher percentage of total resolution 6.