Infantile haemangioma

Infantile hemangiomas (IH) are a type of benign vascular tumor that occur in babies. They appear as a red or blue raised lesion. Typically they begin during the first four weeks of life, grow until about five months of life, and then shrink in size over the next few years. Often skin changes remain following involution. Complications may include pain, bleeding, ulcer formation, heart failure, or disfigurement.Hemangioma on forehead showing signs of early regressionHemangioma on the scalp of a 2-year-old child, in the 'rest stage'Hemangioma of the liver as seen on ultrasoundA liver hemangioma as seen on CT Infantile hemangiomas (IH) are a type of benign vascular tumor that occur in babies. They appear as a red or blue raised lesion. Typically they begin during the first four weeks of life, grow until about five months of life, and then shrink in size over the next few years. Often skin changes remain following involution. Complications may include pain, bleeding, ulcer formation, heart failure, or disfigurement. The underlying reason for their occurrence is not clear. In about 10% of cases they appear to run in families. A few cases are associated with other abnormalities such as PHACE syndrome. Diagnosis is generally based on the symptoms and appearance. Occasionally medical imaging can assist in the diagnosis. In most cases no treatment is needed, other than close observation. Certain cases, however, may result in problems and the use of medication such as propranolol or steroids are recommended. Occasionally surgery or laser treatment may be used. It is one of the most common benign tumors in babies, occurring in about 5%. They occur more frequently in females, white people, preemies, and low birth weight babies. The word 'hemangioma' comes from the Greek haima (αἷμα) meaning 'blood'; angeion (ἀγγεῖον) meaning 'vessel'; and -oma (-ωμα) meaning 'tumor'. Infantile hemangiomas typically develop in the first few weeks or months of life. They are more common in Caucasians, in premature children whose birth weight is less than 3 pounds (1.4 kg), in females, and in twin births. Early lesions may resemble a red scratch or patch, a white patch, or a bruise. The majority occurs on the head and neck, but they can occur almost anywhere. The appearance and color of the IH depends on its location and depth within the level of the skin. Superficial IHs are situated higher in the skin and have a bright red, erythematous to reddish-purple appearance. Superficial lesions can be flat and telangiectatic, composed of a macule or patch of small, varied branching, capillary blood vessels. They can also be raised and elevated from the skin, forming papules and confluent bright-red plaques like raised islands. Infantile hemangiomas have historically been referred to “strawberry hemangiomas” in the past, as raised superficial hemangiomas can look like the side of a strawberry without seeds.Superficial IHs in certain locations, such as the posterior scalp, neck folds, and groin/perianal areas, are at potential risk of ulceration. Ulcerated hemangiomas can present as black crusted papules or plaques, or painful erosions or ulcers. Ulcerations are prone to secondary bacterial infections, which can present with yellow crusting, drainage, pain, or odor. Ulcerations are also at risk for bleeding, particularly deep lesions or in areas of friction. Multiple superficial hemangiomas, more than five, can be associated with extracutaneous hemangiomas, the most common being a liver (hepatic) hemangioma, and these infants warrant ultrasound examination. Deep IHs present as poorly defined, bluish macules that can proliferate into papules, nodules, or larger tumors. Proliferating lesions are often compressible, but fairly firm. Many deep hemangiomas may have a few superficial capillaries visible evident over the primary deep component or surrounding venous prominence. Deep hemangiomas have a tendency to develop a little later than superficial hemangiomas, and may have longer and later proliferative phases, as well. Deep hemangiomas rarely ulcerate, but can cause issues depending on their location, size, and growth. Deep hemangiomas near sensitive structures can cause compression of softer surrounding structures during the proliferative phase, such as the external ear canal and the eyelid. Mixed hemangiomas are simply a combination of superficial and deep hemangiomas, and may not be evident for several months. Patients may have any combination of superficial, deep, or mixed IHs.