Hemangioma (in children)

Synonyms: Juvenile Hemangioma, Strawberry nevus

We notice them as red lesions on the skin, varying in size and shape. They occur very soon after birth. They occur in 2% of newborns, both sexes affected. They most commonly appear on the head and neck (about 80%). They reach maximum in size after 3 to 5 months, extremely rarely they can grow to 18 months of age. After the growth arrests, a process of involution or regression takes place (partial to complete disappearing). This process takes from 3 to 10 years. Almost all hemangiomas level to the skin go away with no treatment required. However, elevated hemangiomas, do not completely regress.

They reason why they form is still unknown. It is presumed that growth factors, hormonal activity and even mechanical factors can cause them to form. There is also a possibility of certain pregnancy or birth factors influencing, but those factors are not to date confirmed as culprits.

They usually appear as soon as the first few weeks after birth, as red, either level or elevated, lesions on the skin. Their size varies from a few mm to over 10cm. Hemangiomas don’t hurt and very rarely cause any functional issues. Since they most commonly appear on the face and neck, they present an esthetical-social issue, firstly for the parents, secondly, during life, for the child itself, if they don’t resolve by themselves or get removed.

There are two main divisions of hemangiomas: depth-wise and size-wise.

• Superficial (capillary)
  Blood vessels in the upper part of the skin are dilatated. They are commonly known as::
  • capillary haemangioma,
  • capillary naevus,
  • strawberry haemangioma or strawberry naevus,
  • haemangioma simplex
• Deep (cavernous)
  They are situated in deeper layers of the skin, and in contrast to superficial ones, they are bluish, soft and look like swelling..
• Mixed
  both of the previous types are presented in one place.

• Localized
  – These are usually small in size, and go into full regression
• Segmental
  They present a significant problem, because:
  • They grow up to 10 times the size of localized ones.
  • n time, they present a major esthetical-social problem.
  • They are commonly associated with other congenital anomalies of the head (posterior fossa abnormality), heart, eye and blood vessels.
  • It is of special importance to consider the conjoined appearance of pelvic and genitourinary region hemangiomas with malformations in the same area.

The diagnosis can often be made based on the appearance of the lesion itself (by eye) and on the information provided from palpation. Ultrasound, CT, MRI or biopsy are rarely necessary..

Bleeding is a complication that usually occurs by injury. However, infection can form, and very rarely other skin cancers can develop on the grounds of hemangiomas.

As hemangiomas in children tend to disappear either partially or completely, their treatment should be considered and applied on:

• Large prominent hemangiomas
• Hemangiomas with an ulceration (wound)
• Hemangiomas that compromise breathing, feeding, eye sight or hearing
• Hemangiomas that reside until school age

Possible treatments are:

• External compression
• High potency topical corticosteroids
• High dose oral corticosteroids.
• Interferon alfa.
• Imiquimod
• Propranolol

• Vaskularni laseri
  The best time is between age 3 and 4, when the hemangioma is completely stabile. Of course, the treatment can be done later on. There are multiple recommended lasers, firstly: frequency-doubled Nd-YAG , pulse dye lasers (PDL), copper bromide, Krypton, KTP lasers and intense pulsed light (IPL) systems

There are no specific risk factors. They often appear in children whose parents had a history of hemangioma.

There is no specific prevention.