A hemangioma is a bright red birthmark made of extra blood vessels that grows in the skin. It is the most common tumor of infancy, but it is not cancer. Most hemangiomas appear in the first weeks of life, grow for several months, and then slowly shrink on their own without any treatment. Treatment is only needed when the growth interferes with vision, breathing, feeding, or causes ulcers that do not heal.
What Causes Hemangioma In Babies And When To Treat
Hemangiomas form when blood vessel cells clump together in the skin instead of spreading out normally. The exact cause is not fully understood, but researchers know it is not caused by anything a mother did during pregnancy. There is no evidence linking hemangiomas to foods, medications, or activities during pregnancy.
What is clear is that hemangiomas are more common in certain groups. They occur more often in girls, in premature babies, in twins, and in babies with a low birth weight. About one in ten babies develops a hemangioma, and the number is higher for babies born before 37 weeks.
The growth follows a predictable pattern. A hemangioma usually appears within the first two to five weeks of life. It grows fastest between one and five months of age. After that, growth slows and eventually stops. Most hemangiomas begin to shrink on their own around the first birthday. The shrinking phase can last several years.
Are Hemangiomas Dangerous?
Most hemangiomas are harmless. They are not painful and do not cause medical problems. The vast majority of babies with a hemangioma need nothing more than regular checkups and time.
Some hemangiomas do require attention. A hemangioma that grows near the eye can press on the eyeball or eyelid and affect vision. One that blocks the nose can make it hard for a baby to breathe. A hemangioma in the mouth or throat can interfere with feeding or breathing. These situations need evaluation by a doctor.
Ulceration is another concern. Hemangiomas can break open on the surface, creating a sore. This happens most often during the rapid growth phase. Ulcerated hemangiomas can be painful and may bleed or become infected. They need treatment to help them heal.
A rare type called a hepatic hemangioma grows inside the liver. Most liver hemangiomas cause no symptoms and need no treatment. But a large one can cause heart problems because it allows blood to flow too quickly. Babies with many skin hemangiomas — usually five or more — should have an ultrasound to check the liver.
When Does a Hemangioma Need Treatment?
Treatment is considered when a hemangioma threatens a vital function or causes complications. The clearest reasons to treat are:
- Interference with vision, breathing, or feeding
- Ulceration that is painful, bleeding, or infected
- Rapid growth that is out of proportion to the normal pattern
- Location on the face in a pattern that suggests an underlying syndrome
Doctors also consider treatment when a hemangioma is likely to leave permanent skin changes. Hemangiomas on the nose, lips, or ears can distort cartilage. Those on the breast or scalp may leave noticeable scars. In these cases, treatment is a choice made by the family and the doctor together, not an emergency.
Most hemangiomas that need treatment are identified by the time the baby is one to three months old. The proliferative phase — the time of fastest growth — is the window when treatment works best. Waiting until a hemangioma has stopped growing makes treatment less effective.
What Are the Treatment Options?
For decades, the standard treatments were surgery, laser therapy, or corticosteroids. Surgery is still used for some hemangiomas, but it is no longer the first choice for most. Laser therapy can help with ulceration and with superficial redness, but it does not stop deep growth. Steroids were effective but carried side effects like poor growth and high blood sugar.
The treatment landscape changed significantly with the discovery that propranolol, a beta-blocker medication, shrinks hemangiomas. Propranolol is now the first-line treatment for hemangiomas that require therapy. It is given as a liquid by mouth, usually twice a day. Most babies take it for six to twelve months.
Propranolol works by narrowing the blood vessels in the hemangioma and slowing the signals that drive its growth. Studies have shown it is effective in the majority of treated infants. It works best when started during the growth phase, which is another reason early evaluation matters.
The medication is not without risks. Possible side effects include low blood sugar, low blood pressure, slow heart rate, and sleep disturbances. Because of these risks, the first dose is often given in a clinic or hospital where the baby can be monitored. After that, most babies take it at home with periodic checkups.
A topical form of propranolol and a related drug called timolol are available as gels. These are used for small, superficial hemangiomas. They are not appropriate for deep or large growths.
What Happens If a Hemangioma Is Left Alone?
Most hemangiomas resolve without any intervention. The natural shrinking process, called involution, begins around age one. Over the next three to five years, the hemangioma gradually becomes softer, flatter, and less red.
About half of hemangiomas leave some trace. The skin may remain slightly lighter or darker than the surrounding area. It may have a subtle texture change or a few visible blood vessels. These residual changes are usually cosmetic and do not require treatment.
The exception is ulcerated hemangiomas. Ulceration can leave a permanent scar, and the scar can be more noticeable than the original hemangioma would have been. This is one reason ulceration is a clear indication for treatment.
It is important to understand that hemangiomas are not caused by trauma. Bumping the area does not make one appear. There is no evidence that any cream, oil, or herbal remedy prevents or shrinks hemangiomas. Products marketed for this purpose have not been validated by clinical trials.
When Should Parents See a Doctor?
Any new growth on a baby’s skin should be seen by a pediatrician. Most of the time, the pediatrician will confirm it is a hemangioma and set a plan for monitoring. The pediatrician may take photos at each visit to track growth objectively.
Parents should seek care sooner rather than later if the hemangioma is near the eye, nose, or mouth. The same applies if the surface breaks open, bleeds, or looks infected. A hemangioma that grows extremely fast — doubling in size within a week — also warrants prompt evaluation.
Referral to a specialist is common for hemangiomas that need treatment. Pediatric dermatologists, pediatric surgeons, and specialized vascular anomaly clinics all manage these birthmarks. The choice of specialist depends on the location and complexity of the hemangioma.
Frequently Asked Questions
Can hemangiomas be prevented during pregnancy?
No. There is no known way to prevent a hemangioma, and nothing a mother does during pregnancy causes one.
Do hemangiomas hurt the baby?
Most hemangiomas are painless. The main exception is an ulcerated hemangioma, which can be painful until it heals.
How long does it take for a hemangioma to go away?
Shrinking usually begins around the first birthday and continues over several years. About half leave a minor skin change that may be permanent.
Is propranolol safe for infants?
Propranolol is the standard treatment for hemangiomas that need therapy, and it is effective in most cases. It has known side effects, so dosing and monitoring are managed by a doctor.
