Infantile hemangiomas, also known as IHs, are benign vascular tumors caused by an abnormal growth of blood vessels. They can form on or beneath the skin. IHs are often referred to as “strawberry marks” due to their color and similar appearance to typical birthmarks. Keep in mind that just because hemangiomas are tumors doesn’t mean they’re cancerous. It is the most common vascular lesion in infants: 4.5% of infants under 1 year of age1,2,4 are affected, and it is even more common in children born prematurely3.
Three things every parent should know.
Learn About IH
Infantile hemangiomas are benign vascular tumors caused by an abnormal growth of blood vessels.
Most infantile hemangiomas are low risk and may improve over time without treatment. However, some can grow quickly or cause complications, so it is important to have a new or changing lesion evaluated by your baby's doctor.
Hemangiomas can appear anywhere on the body but are most common on the face or neck.
They can be flat like a birthmark, form a nodule, or have a plaque-like texture and appearance.
Superficial Hemangiomas
Superficial hemangiomas involve the upper layers of the skin and are typically bright red. They may appear flat at first and can become raised as they grow. This is normally what people think of when they picture infantile hemangiomas.
Deep Hemangiomas
Deep hemangiomas form below the surface of the skin. They tend to have a bluish appearance.
Compound Hemangiomas
Compound hemangiomas have both the traits of superficial and deep hemangiomas.
After determining that your baby has an infantile hemangioma, talk to your baby’s doctor right away. Identifying the type and characteristics of your baby’s hemangioma can help the healthcare provider determine whether monitoring, additional evaluation, or treatment may be appropriate.
Why Does My Baby Have It?
Why Does My Baby Have An Infantile Hemangioma?
At this point, medical science doesn’t fully understand what causes infantile hemangiomas. It is known that babies with certain traits have a higher risk of developing IH. This includes infants born with low birth weights, females, Caucasians, and premature babies.
Why are some babies more at risk of developing an infantile hemangioma?
Among the known risk factors, the most common are:
Very premature birth
Multiple pregnancy
Pregnancy with complications such as placental abnormalities or high blood pressure
If your baby has an infantile hemangioma, it’s important to know this is not your fault. These are common, and their cause isn’t fully understood.
What matters most is making sure your baby is properly evaluated and, if needed, treated early.
The exact cause of infantile hemangiomas is not fully understood. If you notice an infantile hemangioma on your baby, talk with your baby’s healthcare provider about whether monitoring or additional evaluation may be appropriate.
Potential Complications
Infantile Hemangioma Potential Complications
Some infantile hemangiomas can interfere with normal function depending on their size and location5,6. For example, hemangiomas near the eye may affect vision, while those near the nose or mouth may affect breathing or feeding.
Most infantile hemangiomas do not require treatment. However, some may need earlier evaluation depending on their size, location, growth pattern, or potential to cause complications.
Hemangiomas in certain locations may affect vision, breathing, feeding, or other normal functions. Others may ulcerate or have the potential to leave permanent changes to the skin.
Early evaluation can help your baby’s healthcare provider determine whether continued monitoring or treatment may be appropriate.
Fibrofatty tissue
Telangiectasia
Anatomic distortion
Residual scarring
Sequelae after involution of untreated hemangiomas5,6
In some cases, treatment may be recommended to help reduce the risk of complications or permanent skin changes.
Visceral Hemangiomas
Sometimes, infantile hemangiomas can occur inside the body. These are known as visceral hemangiomas. The liver is the most common site, although hemangiomas can also occur in other organs.
Depending on their size, location, and number, visceral hemangiomas can sometimes cause serious complications. Signs and symptoms can vary depending on where they are located, so parents should talk with their baby’s healthcare provider if they have concerns about unusual symptoms.
Babies with multiple infantile hemangiomas on the skin may have a higher risk of hemangiomas in the liver. Infants with 5 or more cutaneous infantile hemangiomas are generally recommended to have an abdominal ultrasound to screen for hepatic hemangiomas.
Hemangiomas as Indicators of Other Concerns
At times, IHs can also be a sign of an underlying issue. Some large or segmental infantile hemangiomas of the face or scalp can be associated with other underlying conditions, such as PHACE syndrome. Your baby’s healthcare provider can determine whether additional evaluation or testing may be appropriate.
Risk of Bleeding
Some infantile hemangiomas can develop an open sore, known as an ulceration, which may cause pain, bleeding, or infection. If your baby’s hemangioma develops an open sore, begins bleeding, or appears painful, contact your baby’s healthcare provider.
Skin Changes
Although most IHs resolve on their own by the time children reach 7 to 9 years, they often leave behind permanent skin changes. About 69% of hemangiomas can leave permanent residual lesions if untreated. This can include scars, extra skin, extra fatty tissue, and the like. And about 1 in 3 facial hemangiomas will result in disfigurement from permanent soft tissue distortion.
While these are often cosmetic, they can still be problematic for the child, especially if they’re in a spot that isn’t generally covered by clothing. Because of the potential for permanent skin changes, there’s a window of opportunity to address an IH.
Why & When to Consult
Why & when to consult a physician.
Why should you consult a physician?
If you notice a mark or lesion on your baby’s skin, speak with your doctor so it can be properly evaluated.
The good news is that most infantile hemangiomas are mild and resolve on their own without treatment.
In some cases a hemangioma may need closer attention, especially if it could affect function or lead to complications. Your doctor can help determine the right next steps.
Most infantile hemangiomas do not require treatment. Some, however, may need closer monitoring or evaluation by a healthcare provider with experience treating infantile hemangiomas.
When should you consult a physician?
Only about 30% of hemangiomas are visible at birth. Most hemangiomas don’t appear until the first few weeks, or sometimes even months, after birth. And they tend to grow after their first appearance. IHs grow fastest between 1 and 3 months of age.
If you notice this happening, don’t panic. Check your baby often, taking note of any new or changing marks on their body. Just as you probably count your baby’s ten fingers and ten toes, keep an eye on any distinctive markings and mention them to your baby’s doctor right away – particularly if they’re changing or growing. Even though most IHs are harmless, identifying and diagnosing them early on is key.
As soon as an infantile hemangioma appears, it is vital to consult your baby’s doctor. Increased monitoring during the proliferation phase is important. The doctor will arrange for regular follow-up visits or refer your child to a doctor with expertise in infantile hemangioma.
Do not hesitate to report any changes in the size or appearance of the infantile hemangioma to your doctor. Because most infantile hemangioma growth occurs early in infancy, timely evaluation of higher risk IHs is important.
It may be helpful to take pictures of your child’s hemangioma regularly so that your doctor can more easily monitor its progress.
Diagnosis & Treatment
Diagnosis & treatment of infantile hemangioma.
How is the diagnosis made?
The diagnosis and determination of the degree of severity of the infantile hemangioma are made during the clinical examination.
Your doctor or the pediatric hemangioma expert will assess the severity of the hemangioma by considering:
Your child’s age
The number and location of the hemangioma(s)
The size of the hemangioma and its appearance (color, thickness, etc.)
Its evolution: is the hemangioma growing or stable? Photos of your child since birth can be of great help.
In some cases, the doctor may need to perform additional tests (medical ultrasound, MRI scan, etc.) to confirm the diagnosis.
Infantile hemangioma treatment
HEMANGEOL® (propranolol hydrochloride) oral solution is indicated for the treatment of proliferating infantile hemangioma requiring systemic therapy. Treatment is generally started on babies between 5 weeks and 5 months of age. Because of this window of time, it’s important to note any hemangiomas to your baby’s doctor as soon as you notice them.
HEMANGEOL is administered twice a day, given to your baby during or right after a feeding. Your doctor will gradually increase the dosage, then readjust dosage regularly as your baby’s weight changes. Maintenance dose is given for 6 months.
HEMANGEOL comes with a graduated oral dosing syringe and syringe adapter for easy administration, and comes in strawberry and vanilla flavors to help your baby take their medicine.
Treatment Outlook
60% of patients achieved complete or near-complete resolution of their IH within 6 months (n=101). In trial studies, HEMANGEOL greatly outperformed the placebo, where only 4% of infants saw such promising results. 88%* of infants on HEMANGEOL saw improvement after just 5 weeks of treatment (n=55).
Side Effects
The most common side effects of HEMANGEOL include sleep disorders, aggravated respiratory tract infections, diarrhea, and vomiting. Please see the Important Safety Information below and the full Prescribing Information and Medication Guide for additional safety information. In trials, fewer than 2% of patients stopped treatment due to adverse reactions.
*Of patients on HEMANGEOL 3.4 mg/kg/day for 6 months who were considered successes, 10% required retreatment for recurrence of hemangiomas.
Learn more about HEMANGEOL.
Discover the first and only FDA-approved treatment for proliferating infantile hemangioma requiring systemic therapy.
Léauté-Labreze et al – Infantile Haemangioma – Lancet 2017 Jul 1;390 (10089): 85-94
Munden et al – Incidence and demographics of IH – BJD 2014, 170; 907-913
Goelz R et al. Incidence and treatment of infantile hemangioma in preterm infants. Arch Dis Child Fetal Neonatal Ed 2015; 100 F85-91
Volc-Platzer et al. – Poster ESPD 2014
Darrow D, Greene AK, Mancini AJ, Nopper AJ. Diagnosis and Management of Infantile Hemangioma. Pediatrics. 2015 Oct;136(4):1060-1104.
Baselga E, Roe E, Coulie J, Munoz Fania Z, Boon LM, McCuaig C et al. Risk Factors for Degree and Type of Sequelae After Involution of Untreated Hemangiomas of Infancy. JAMA Dermatol. 2016 Nov;152(11):1239-1243.
Important Safety InformationImportant Safety Information for Parents
USE: HEMANGEOL (propranolol hydrochloride) oral solution is a prescription medicine used to treat proliferating infantile hemangioma (a type of birthmark) requiring treatment throughout the body.
WHO SHOULD NOT TAKE HEMANGEOL?: Do not give HEMANGEOL to your child if they were born early and are less than 5 weeks corrected age; weigh less than 4.5 lbs; have asthma or a history of breathing problems (bronchospasm); have certain heart conditions (such as slow heart rate, heart block, or heart failure); have very low blood pressure; have high blood pressure caused by a tumor on the adrenal gland, called “pheochromocytoma”; or are allergic to propranolol or any of the ingredients in HEMANGEOL.
