A haemangioma (also known as a strawberry birthmark) is a type of birthmark caused by an abnormal collection of abnormal blood vessels just below the skin.

Incidence/Age/Sex

Haemangiomas are very common; about 10% of babies are affected. 15 - 20% of babies have more than one haemangioma. They typically appear in the first few weeks of life. Females are more commonly affected than males (3:1). Haemangiomas are less common in dark skinned races and may occur anywhere on the body surface; however, 60% are in the head and neck area.

Signs & Symptoms

The typical haemangioma is not be present at birth; most appear in the first few weeks of life as a small, flat, red blemish (“herald patch”). The blemish will change day by day initially to form some flat spots which then become raised and join together to form a red swelling. Subsequently all haemangiomas follow a typical pattern of behaviour; initially there is rapid growth in area and depth (“proliferative phase”). After the proliferative phase, which lasts about six months, they remain stable (“plateau phase”) for a period of months or occasionally years before beginning to fade away (involution).

The appearance of a haemangioma depends upon how deep it is in the skin and the growth phase in which it is observed. Early growing lesions are typically elevated with a bright red, irregular surface (“strawberry birthmark”). If the haemangioma is in the deeper layers of the skin they may produce a blue swelling.

Involution typically begins with the fading of the colour to purple and the development of colourless or grey areas with softening of the birthmark and then shrinkage of the lesion. The end result may be complete resolution or the production of a scar consisting of redundant, wrinkly skin. About 50% of haemangiomas will have resolved by the age of 5 years.

Parents are usually advised that no treatment is required as most will resolve without leaving any scar or deformity. Some haemangiomas develop complications (see below) that produce additional signs and symptoms.

Causes/preventions

The cause of these birthmarks is unknown. Contrary to many old wives’ tales the appearance of a haemangioma has nothing to do with what the mother ate or saw during her pregnancy. They are not hereditary, although because they are so common more than one family member may be affected. When a haemangioma appears it is impossible to predict how large it will grow, how long it will persist and whether it will leave any residual mark after it resolves.

No treatment has been scientifically proven to prevent the development of haemangiomas. Preliminary work has suggested that it may be possible to prevent the growth phase of haemangioma if they are treated with a laser called the flash lamp pulsed dye laser as soon as possible after they appear. A major research project at Birmingham Children’s hospital and Birmingham Heartlands hospital is currently underway to see if laser treatment can prevent the growth of haemangioma by treating them as soon as they occur.

Complications of disorder

Most haemangiomas resolve without problems and without scarring; however, some lesions will develop complications, most typically during the early proliferative growth phase. Complications include: bleeding, ulceration, infection, and obstruction of visual fields, airway obstruction, heart failure and bleeding disorders.

The rapid growth of proliferating haemangiomas may also distort or destroy growing structures; this may have major implications when structures such as the nose, lips, ears or eyes are involved.

Tests

For most children with haemangiomas no special tests are needed; if complications develop then some tests might be need.

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