Hemangiomas in Children

Hemangiomas in children are a common topic of interest for many parents and caregivers. Hemangiomas are benign (non-cancerous) tumors of blood vessels that usually appear on the skin or under the skin of infants. They can vary in size, shape, color, and location, and they often change over time. In this blog post, I will answer some frequently asked questions about hemangiomas in children, based on the latest scientific evidence and expert opinions.

What causes hemangiomas in children?

The exact cause of hemangiomas in children is not fully understood, but researchers believe that they are related to abnormal development of blood vessels during fetal life. Some factors that may increase the risk of hemangiomas include:

- Premature birth or low birth weight

- Female sex

- Caucasian race

- Multiple gestation (twins, triplets, etc.)

- Maternal placenta problems

- Family history of hemangiomas

How common are hemangiomas in children?

Hemangiomas are the most common benign tumor of infancy, affecting about 4 to 10 percent of Caucasian infants. They are less common in Asian and African-American infants, and they are more common in girls than boys, with a ratio of about 3 to 5:1. Most hemangiomas appear within the first few weeks after birth, and they usually grow rapidly during the first six months of life. This is called the proliferative phase. After that, they tend to stabilize and then gradually shrink over the next few years. This is called the involution phase. By the time the child is 5 years old, most hemangiomas are significantly smaller or gone.

What are the types of hemangiomas in children?

There are three main types of hemangiomas in children, depending on their appearance and location:

- Superficial hemangiomas: These are the most common type of hemangiomas, and they appear as raised, bright-red patches on the skin, sometimes with a textured surface. They are also known as strawberry marks. They can be focal (in one place) or diffuse (over a larger area).

- Deep hemangiomas: These are less common than superficial hemangiomas, and they appear as bruise-like or bluish lumps under the skin. They are often diagnosed when swelling becomes apparent, usually around 2 to 4 months of age.

- Mixed hemangiomas: These are hemangiomas that have both superficial and deep components, and they can have a variable appearance and behavior

How are hemangiomas in children diagnosed?

Most hemangiomas in children can be diagnosed by a physical examination and a medical history. Sometimes, additional tests may be needed to confirm the diagnosis or to rule out other conditions. These tests may include:

- Ultrasound: This is a painless and non-invasive test that uses sound waves to create images of the hemangioma and the surrounding tissues. It can help determine the size, depth, and blood flow of the hemangioma.

- Magnetic resonance imaging (MRI): This is a test that uses a strong magnetic field and radio waves to create detailed images of the hemangioma and the adjacent structures. It can help assess the extent of the hemangioma and its possible effects on the brain, the eyes, the airway, or other organs.

Biopsy: This procedure is rarely used and only reserved for the cases with suspicious malignancy.

How are hemangiomas in children treated?

Most hemangiomas in children do not require any treatment, as they tend to resolve on their own over time. However, some hemangiomas may need treatment if they cause complications or interfere with vital functions, such as breathing, vision, hearing, feeding, or urination. The treatment options for hemangiomas in children include:

- Observation: This is the most common approach for hemangiomas that are small, harmless, and not causing any problems. The child's doctor will monitor the hemangioma regularly and advise the parents on how to care for it and what to expect.

- Medications: These are drugs that can help slow down or stop the growth of hemangiomas, or reduce their size and redness. The most commonly used medications for hemangiomas are propranolol and timolol, which are beta-blockers that work by narrowing the blood vessels. Other medications that may be used include steroids, vincristine, and sirolimus, which have different mechanisms of action and side effects. Medications can be given orally, topically, or by injection, depending on the type, size, and location of the hemangioma.

- Laser therapy: This is a procedure that uses a beam of light to destroy the blood vessels in the hemangioma, or to reduce their redness and thickness. Laser therapy can be done alone or in combination with medications, and it may require multiple sessions. It is usually reserved for superficial hemangiomas that are not responding to other treatments, or for hemangiomas that are located on the face or other visible areas.

- Surgery: This is a procedure that involves removing the hemangioma completely or partially, using a scalpel, a scissors, or a cautery device. Surgery can be done alone or in combination with other treatments, and it may require general anesthesia, local anesthesia, or sedation. It is usually reserved for hemangiomas that are large, deep, ulcerated, infected, or causing significant deformity or functional impairment.

What are the possible complications of hemangiomas in children?

Hemangiomas in children are generally benign and harmless, but they can sometimes cause complications, depending on their size, location, and growth rate. Some of the possible complications of hemangiomas in children include:

- Ulceration: This is a condition where the skin over the hemangioma breaks down and forms an open sore. It can cause pain, bleeding, infection, and scarring. It is more common in hemangiomas that are large, rapidly growing, or located in areas of friction or pressure, such as the diaper area, the mouth, or the neck.

- Bleeding: This is a condition where the hemangioma ruptures and bleeds, either spontaneously or due to trauma. It can cause pain, shock, and anemia. It is more common in hemangiomas that are large, deep, or ulcerated, or located in areas of high blood flow, such as the scalp, the face, or the liver.

- Infection: This is a condition where the hemangioma becomes infected by bacteria, fungi, or viruses. It can cause fever, swelling, pus, and systemic illness. It is more common in hemangiomas that are ulcerated, bleeding, or located in areas of poor hygiene, such as the groin, the armpit, or the ear.

- Disfigurement: This is a condition where the hemangioma causes cosmetic or functional impairment, such as distortion of the facial features, obstruction of the vision, or interference with the speech. It can affect the child's self-esteem, social development, and quality of life. It is more common in hemangiomas that are large, visible, or located on the face, the head, or the neck.

- Organ dysfunction: This is a condition where the hemangioma affects the function of an internal organ, such as the brain, the eye, the airway, the heart, the liver, or the kidney. It can cause neurological problems, glaucoma, stridor, congestive heart failure, portal hypertension, or renal failure. It is more common in hemangiomas that are large, deep, or multiple, or located in critical areas, such as the brain, the eye, the airway, the heart, the liver, or the kidney.

What are the long-term outcomes of hemangiomas in children?

The long-term outcomes of hemangiomas in children depend on several factors, such as the type, size, location, and treatment of the hemangioma, as well as the presence or absence of complications. In general, most hemangiomas in children have a good prognosis, as they tend to resolve spontaneously or respond well to treatment. However, some hemangiomas may leave behind residual effects, such as:

- Scarring: This is a condition where the hemangioma leaves a permanent mark on the skin, such as a scar, a patch, or a telangiectasia (a small blood vessel). It can affect the appearance and the texture of the skin, and it may require further treatment, such as laser therapy, surgery, or skin grafting.

- Deformity: This is a condition where the hemangioma causes a permanent change in the shape or structure of the affected area, such as a dent, a bump, or a contracture. It can affect the function and the mobility of the affected area, and it may require further treatment, such as surgery, orthotics, or physical therapy.

- Psychological distress: This is a condition where the hemangioma causes emotional or behavioral problems, such as anxiety, depression, low self-esteem, or social isolation. It can affect the child's mental health