Haemangiomas

A haemangioma is a collection of small blood vessels. They usually appear a few days or weeks after birth. They are sometimes called ‘strawberry marks’ because the surface of a haemangioma may look like the surface of a strawberry.

The cause of haemangiomas is not fully known. There is some evidence to suggest that some haemangiomas may arise from placental cells.

About one in every ten babies will have a haemangioma. They are more common in girls, following IVF, in premature and low birth weight babies, and multiple births (twins or triplets etc.). Haemangiomas are not inherited, but because they are common, families often report that a relative has had a haemangioma in childhood.

Haemangiomas can be superficial or deep, or a combination of both.

Superficial haemangiomas appear near to the outer layer of the skin. They usually appear as a raised, bright red area of skin, which may feel warm.

Deep haemangiomas may appear as a bluish swelling, because the abnormal blood vessels are deeper in the skin. Sometimes they are not noticeable until as late as three months of age, if there is no superficial component.

Haemangiomas are not usually present at birth, but develop a few days or weeks later. They often grow rapidly in the first three months. Deep haemangiomas tend to grow for longer than superficial ones.

Most children only develop one haemangioma. Sometimes a child can have multiple haemangiomas in various parts of the body. This happens most often in multiple births.

Haemangiomas can appear anywhere on the body, but the majority of haemangiomas appear on the head or neck. Haemangiomas can also appear on the organs inside the body, most commonly the liver.

Haemangiomas are usually diagnosed by doctors being able to see them on the skin. We usually don’t need any special tests, though ultrasound and/or MRI scan may occasionally be required.

In most cases, haemangiomas just need careful skin care.

As the blood vessels in a haemangioma are very near the surface of the skin, they can bleed if they are knocked or scratched. Try to keep your nails and your children’s nails short and buffed smooth, so that they don’t catch the surface of the haemangioma.

If the haemangioma starts to bleed, apply pressure with a clean cloth or gauze (not tissue) for at least five minutes. If blood soaks through, place another one on top and keep up the pressure. If the bleeding continues beyond 10 minutes, go to your nearest A&E or urgent care centre for further assistance.

The surface of the haemangioma is delicate and may become dry. Avoid using bubble bath and rinse off any soap or shampoo carefully and gently pat the area dry afterwards. You can apply a thin layer of Vaseline® gently over the top of the haemangioma to help prevent the surface from becoming dry.

If your child has a haemangioma in the nappy area, apply Vaseline® or a similar greasy product at each nappy change. Wet wipes can be irritating, so it’s better to use damp cotton wool or gauze.

Haemangiomas need protection from the sun in the same way as the rest of your child's skin. Use a high factor sun block on all areas of exposed skin and use a hat to protect your child’s face and/or an umbrella over the buggy or pushchair.

Most haemangiomas don’t require any treatment, but there are circumstances where treatment might be needed.

Ulcerated haemangiomas

Occasionally, haemangiomas can develop an open sore or ulcer, which is painful. Ulcers can become infected and may need treatment with a topical antibacterial cream and dressings. Ulcerated areas may leave a scar.

Haemangiomas near the mouth, in the nappy area or in skin folds, are most vulnerable to ulceration. The nappy can rub haemangiomas and contact with poo or urine can worsen ulceration.

If your child’s haemangioma develops an ulcer, it will need special attention until it heals:

• Wash the area twice a day to keep it clean.
• Add some Dermol® 600 bath emollient to the bath water and gently pour it over the area.
• Leave the area to dry naturally- do not rub or pat it dry.
• Once the area is dry, cover the whole haemangioma with a non-sticky silicone dressing. These are available on prescription from your GP.

Haemangiomas on the lips

Haemangiomas on the lips may become ulcerated and because ulcers are painful, your child may not want to feed. Pain relief before feeding can help. It can also help to put some Vaseline® on the teat of the bottle (or around your nipple if you are breast feeding) to reduce friction.

Due to their location, it is impossible to put a dressing on an ulcerated lip, and a child’s drooling means lip ulcers often take a long time to heal. Treatment with beta blockers may speed up healing.

Haemangiomas near the eye

Haemangiomas near the eye can have long-term effects on a child’s vision, so vision should be checked by a specialist eye doctor (ophthalmologist). The haemangioma can press on the eyeball, causing it to go slightly out of shape, affecting how images reach the retina, which in turn alters the messages sent to the brain from the eye.

If the haemangioma gets in the way of a child’s field of vision, a condition called ‘lazy eye’ (amblyopia) can develop, because the brain will filter out the impaired image from the affected eye. Over time, the affected eye loses the ability to see accurately. It is treated by encouraging the brain to use the lazy eye instead of relying on the unaffected eye. This is usually done by covering up the unaffected eye or blurring its vision with eye drops.

Haemangiomas that are blocking vision may need treatment with beta blockers.

Haemangiomas obstructing the airway

Haemangiomas on the jaw, chin or neck can sometimes be associated with breathing difficulties. The first sign of this is a rasping sound with each indrawing of breath (stridor). If your child is rasping you should take them to A&E for urgent assessment and treatment.

Treatment will depend on the size and location of your child’s haemangioma.

Pain relief

Haemangiomas are painful if ulcerated, so your child may need regular pain relief. If your child isn’t in too much pain, paracetamol may be enough. If the ulcerated area is large and/or around the lip or nappy area, stronger pain medicines such as morphine may be needed. Your GP can advise on pain relief medicines. Giving pain relief before dressing changes can be helpful.

Beta blocker medicines

If your child has a haemangioma that is impairing a vital function, ulcerated, or in a cosmetically sensitive site such as the nose, ear or lip they may be prescribed propranolol or atenolol, usually given as a liquid. Smaller haemangiomas may benefit from a gel beta blocker called timolol. Treatment may need to continue for up to 18 months or longer. More information on each type of beta blocker is available on our website.

Most haemangiomas will have disappeared completely by the age of five to seven years. Large haemangiomas may continue to get smaller until your child is about eight to ten years old.

Depending on the size and location of the haemangioma, there may be little sign it ever existed. Occasionally the affected area of skin might stay lighter, darker or more red than the rest of your child’s skin, depending on their skin tone.

Some haemangiomas affecting the ear or nose can cause distortion, which very occasionally might need plastic surgery.

There are lots of resources to help you support your child growing up with a visible difference, and to help them grow in confidence:

• Changing Faces is a charity that provides support and resources for those with a visible difference:Changing Faces website
• Ask your specialist team for further support and signposting via MyGOSH

At GOSH:

Birthmark Unit, Great Ormond Street Hospital, London WC1N 3JH Tel: 020 7405 9200 extension 1113

Out of hours, take your child to your local Accident and Emergency (A&E) department. Staff there can always contact GOSH for advice if needed.

Support groups:

The Birthmark Support Group offers advice and support to anyone affected by a birthmark.

Telephone: 07825855888

Birthmark Support Group website

Changing Faces supports anyone affected by a visible difference.

Call them on 0845 4500 275

Changing Faces website