What is the typical timeframe for the disappearance of a strawberry hemangioma?

Timeframe for Strawberry Hemangioma Disappearance

Most strawberry hemangiomas (infantile hemangiomas) begin to involute by 12 months of age, with 90% of involution complete by 4 years of age. 1

Natural History of Infantile Hemangiomas

Infantile hemangiomas follow a predictable life cycle with distinct phases:

Growth Phase

• Typically appears before 4 weeks of age 1
• Most rapid growth occurs between 5-7 weeks of age 1
• 80% of growth is completed by 3 months 1
• Growth is generally complete by 5 months of age 1
• Deep hemangiomas may appear later and grow somewhat longer 1

Involution Phase

• Begins between 6-12 months of age 1
• First signs include central clearing or graying of the surface 1
• Lesions flatten and shrink from the center outward 1
• Involution proceeds more slowly than growth 1
• Newer evidence shows 90% of involution is complete by 4 years of age 1
• Older literature suggested involution proceeded at 10% per year (50% resolved by 5 years, 90% by 9 years) 1

Residual Changes After Involution

Even after complete involution, approximately 50-70% of infantile hemangiomas leave behind residual skin changes 1:

• Telangiectasia (small dilated blood vessels)
• Fibro-fatty tissue
• Redundant skin
• Anetoderma (loss of elastic tissue)
• Dyspigmentation
• Scarring

By 4 years of age, it's usually possible to determine whether these residual changes will persist 1.

Factors Affecting Involution Timeline

Several factors may influence how quickly and completely a hemangioma involutes:

1. Location: Facial hemangiomas may have different involution patterns than those on the trunk or extremities 1

2. Size and depth: Larger and deeper hemangiomas may take longer to involute 1

3. Type: Superficial hemangiomas typically involute faster than deep or mixed types 1

4. Segmental pattern: Segmental hemangiomas may have a higher risk of incomplete involution with residual changes 1

Management Considerations

For most uncomplicated strawberry hemangiomas, observation is appropriate as they will involute naturally 2. However, parents should be educated about:

• The expected natural history and timeline of involution
• Potential for residual skin changes even after complete involution
• Signs that would warrant medical attention (rapid growth, ulceration, bleeding, functional impairment)

For high-risk hemangiomas (facial location, functional impairment, ulceration risk, or potential disfigurement), early referral to a specialist is recommended, ideally between 5-7 weeks of age when rapid growth typically begins 2.

Key Points for Parents

• Most growth occurs in the first 5 months of life
• Involution begins around 1 year of age
• The majority of involution is complete by 4 years
• Some residual skin changes may persist even after complete involution
• Serial photographs can be helpful to document the natural regression process

Understanding the typical timeline for strawberry hemangioma involution helps set appropriate expectations and guides management decisions regarding observation versus intervention.