Key takeaways: Infantile hemangiomas often appear in the first weeks and grow most quickly in the first few months. Most shrink over years without treatment. Hemangiomas near the eyes, nose, lips, ears, or diaper area, large ones, or many hemangiomas should be evaluated early, ideally by about 1 month of age. Effective treatment is available.
Infantile hemangiomas are the most common benign tumor of infancy. They’re made of extra blood vessels and often look like a bright red, raised “strawberry” mark. Some are deeper and look bluish.
Timeline
- Birth to a few weeks: may be absent or look like a faint red, white, or bruise-like patch.
- First months: grow quickly. The AAP guideline notes that most growth happens in the first few months, often by about 3 to 5 months.
- Later: growth slows, then the hemangioma gradually shrinks and fades over years. Some leave behind skin changes, such as extra skin or visible blood vessels.
Most Don’t Need Treatment
Small hemangiomas in low-risk locations often only need monitoring. Taking photos over time helps you and your doctor track changes.
When Early Evaluation Is Important
The AAP’s 2019 guideline recommends early evaluation, ideally by about 1 month of age, for high-risk hemangiomas, including those:
- Near the eye, which can affect vision.
- On the nose, lips, or ears, where they may cause lasting disfigurement.
- In the diaper area or skin folds, where they may break down into painful sores.
- Large or segmental (covering an area like part of the face), which may be linked to other conditions.
- Five or more hemangiomas on the skin, which may mean hemangiomas in internal organs like the liver.
- On the lower face or neck in a “beard” distribution, which can be associated with airway hemangiomas. Noisy breathing needs urgent attention.
- Along the midline of the lower back, which may be linked to spine problems.
Treatment
- Oral propranolol is the first-line medicine for hemangiomas that need treatment. It’s most effective when started during the growth phase. It requires monitoring by a doctor.
- Topical timolol may be used for small, thin hemangiomas.
- Laser or surgery may help with leftover skin changes later.
Ulceration
Some hemangiomas break down into open sores, especially in the diaper area or on the lip. These can be painful and need medical care.
Call your baby’s doctor promptly if: a hemangioma is growing quickly, is near the eye, nose, lips, ears, or diaper area, breaks open or bleeds, or your baby has five or more. Seek urgent care for noisy breathing, especially with a hemangioma on the lower face or neck.
The Bottom Line
Most hemangiomas fade on their own, but some need early treatment. Have your baby’s doctor look at any hemangioma early, ideally by 1 month, especially in high-risk areas.
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Sources
- Krowchuk DP, Frieden IJ, Mancini AJ, et al; Subcommittee on the Management of Infantile Hemangiomas. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019;143(1):e20183475.
- Chang LC, Haggstrom AN, Drolet BA, et al. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics. 2008;122(2):360-367.
- Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015;372(8):735-746.
- American Academy of Dermatology. Hemangiomas. https://www.aad.org
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
