Strawberry hemangiomas

When our son was two weeks old, a pink mark appeared between his nose and mouth. Since then the mark has grown to almost the size of a dime and has become bright red and slightly raised. Our doctor has told us it is a strawberry hemangioma birthmark and will most likely get bigger. We are upset because the mark is in a prominent spot and is the first thing people notice about our son. How large is it likely to get, and what, if anything, can be done to remove this mark?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Strawberry hemangiomas are the most common tumors of infancy. I say tumor, not as it is typically used to mean cancer, but rather, meaning a collection of cells. In the case of hemangiomas, the collection of cells are those that make up tiny blood vessels. Strawberry hemangiomas, while they are technically birth marks, are often not noticed at birth. In fact, they usually do not become obvious until the first few weeks of life. These occur more often in females than males and are more commonly seen in Caucasian infants than in other racial groups. The vast majority of these occur as one solitary mark. However, in about 20 percent of these infants, more than one may be present.

Probably the most concerning problem for parents associated with these mostly benign birth marks is that they undergo rapid growth over the first six to ten months of life. Thus, what began as a mild blemish can become a quite noticeable mark on the body, usually the face. After this rapid growth phase, it's size only increases in proportion to the child's normal growth. Then over the next several years, the red color of the hemangioma begins to fade the mark dissolves away. Most of the time, there is little if any mark left behind. However, some may have pale scar where the hemangioma used to be. Strawberry hemangiomas completely resolve in 50 percent of children by age five and 70 percent by age seven. The rest show gradual fading completed by the time they reach the teenage years.

The vast majority of children with strawberry hemangiomas experience no complications. However, there are a few who do encounter some problems. In less than five percent of children, the hemangioma can leave a divot in the skin during its fading away phase. These usually occur when the lips are involved. In addition, uncommonly, the hemangioma can enlarge to involve structures vital to eyesight or breathing. Hemangiomas that involve the eyelids can hamper eyesight by their growth, which in turn causes the eyelid to droop. While this condition is transient, because the hemangioma will fade away, having the eyesight blocked by the eyelid can cause significant problems with the development of correct vision. In addition, these birthmarks can rarely involve the inside of the mouth and throat which could cause difficulty breathing.

Because strawberry hemangiomas rarely cause significant medical or cosmetic problems, treatment is usually reserved for those who are at high risk for complications. In these cases, high doses of steroid medication given orally are usually first tried. In addition, there is now a good amount of experience using certain laser therapy techniques. However, the use of this technology has not yet become widespread.

I am sure your baby's appearance is quite a distressing factor for you. Unfortunately, it is impossible to predict exactly how much larger it will get. And anytime there are unknown factors, it will certainly cause more stress for you. First, I would suggest to you that the overwhelming majority of babies with strawberry hemangiomas located in the spot you describe have no medical complications arising from them. In addition, the odds are also way in your son's favor that it will resolve over time causing little or no mark by the time he reaches school age. I would advise against any massaging as this will not make it resolve any faster, and in fact, you could cause some bleeding within the hemangioma which could cause complications or scarring. To date, there is no topical medications or creams that have proven to be effective in reducing these birthmarks.

I would talk to your doctor about your concerns. Specifically, ask if you can have him show you a number of "before and after" pictures from pediatric dermatology texts. Being able to actually see cases of children who have had strawberry hemangiomas more extensive than your son's which resolved on their own may ease your mind. And finally, having a dermatologist examine it may be helpful but may also be a waste of your time and money because most are hesitant to do any treatment unless there is a significant medical or cosmetic risk. On the other hand, if talking to your doctor has not reassured you, getting a second opinion from a dermatologist would certainly not be unreasonable and could do a lot to arm you with more information.

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