Hemangiomas: Types, Symptoms, Causes, Prevention & Treatment

Hemangiomas, benign growths comprised of blood vessels, are most commonly observed in infants and young children, affecting up to 10% of newborns. While they manifest anywhere on the body, one can generally see them on the face, scalp, and neck. 

Hemangiomas got their name from two essential words in Greek: "haima," which means blood, and "angeion," which means vessel. So, when we say "hemangioma," we're talking about a "blood vessel tumor" or a "tumor made of blood vessels."

Thus, hemangiomas are not cancerous and are essentially collections of blood vessels that don't develop normally. These blood vessels can look different in size and shape and might show up as raised or discolored spots on the skin or even inside the body, depending on their location.

The global prevalence of hemangiomas fluctuates depending on the population under investigation, but a general estimate suggests that approximately 1 in every ten newborns will develop a hemangioma. A 2010 study published in the journal Pediatrics found that the prevalence of hemangiomas in newborns in the United States was 1.1%. In 2011, a study published in the journal Dermatology reported that most hemangiomas in European newborns stood at 2.6%. In India, hemangiomas exhibit a higher prevalence compared to other regions worldwide. A study conducted in India revealed that hemangiomas in newborns were 4.3%, in contrast to rates ranging from 1.1% to 2.6% in various other countries. A 2003 study published in the Indian Journal of Dermatology, Venereology, and Leprosy disclosed that the prevalence of hemangiomas in Indian newborns was 4.3%.

The exact cause of hemangiomas is unknown. However, some risk factors may increase the likelihood of developing hemangiomas. These risk factors are:

• Vascular development abnormalities: Hemangiomas are due to irregularities in the development of blood vessels during fetal growth. These anomalies result in an excessive proliferation of blood vessels.
• Genetic influences: Emerging evidence points to genetic factors contributing to hemangioma formation. Specific genetic mutations and a family history of hemangiomas may increase the susceptibility to these growths.
• Gender disparity: Research, such as the study by Haggstrom AN, Drolet BA, and Baselga E, has revealed that hemangiomas exhibit a notable gender disparity, affecting females more frequently than males, with a female-to-male ratio of approximately 3:1. This discrepancy hints at potential hormonal involvement.
• Premature birth: Premature infants face an elevated risk of developing hemangiomas, as indicated by studies like the one published by Chang LC, Haggstrom AN, and Drolet BA. Premature birth is a significant risk factor, potentially due to the underdeveloped vascular system in preterm infants.
• Hereditary factors: Research findings suggest that a "family history" of hemangiomas or other vascular anomalies may elevate the likelihood of an individual developing a hemangioma. It underscores a possible genetic predisposition within certain families.
• Multiple births: The study by Zheng JW, Zhang L, and Zhou Q highlights that infants born as part of "multiple births," such as twins or triplets, have a slightly higher risk of hemangioma occurrence than singletons. This factor underscores the complexity of hemangioma risk factors.

There are different types of hemangiomas and each type manifests differently.  The following are the types of hemangiomas:

Infantile hemangiomas:

• These represent the most prevalent form of hemangiomas, accounting for 80% of cases.
• Typically, they appear shortly after birth or within the first few weeks of life
•  and have a remarkable growth phase followed by a gradual regression. 

Congenital hemangiomas:

• In stark contrast to infantile hemangiomas, these are present from birth.
• They are of two subtypes: rapidly involuting congenital hemangiomas (RICH), constituting approximately 60%, and non-involuting congenital hemangiomas (NICH), comprising 40%.
• This classification provides insights into their behavior and development. 

Deep hemangiomas:

• These hemangiomas lie at deeper layers within the skin or muscles and organs.
• Although less common than superficial hemangiomas, they present challenges in terms of treatment due to their depth.
• The exact occurrence percentage varies but generally falls below that of superficial hemangiomas. 

Segmental hemangiomas:

• Following a segmental distribution, these hemangiomas affect specific body regions, such as limbs or the face.
• Less frequently encountered than localized hemangiomas, they may be associated with additional developmental concerns.
• Their occurrence percentage is estimated to be in the range of 20-30% of all cases. 

NICH (Non-Involuting Congenital Hemangioma):

• NICH stands out as a subtype of congenital hemangioma that doesn't undergo the same regression phase as infantile hemangiomas.
• These hemangiomas are present from birth and tend to persist into adulthood.
• Approximately 40% of congenital hemangiomas are NICH. 

The doctors recognize the symptoms associated with hemangiomas. Early detection helps better manage hemangiomas, thereby decreasing the probability of complications. Some of the common symptoms of hemangiomas are as follows:

• Distinctive skin marks: Hemangiomas are noticeable, often red or bluish patches on the skin's surface, which may appear as birthmarks.
• Swift growth phase: Many hemangiomas experience a period of rapid enlargement, often occurring within the first few months of life, making them grow significantly in size.
• Swelling and raised texture: The affected skin area becomes swollen and feels raised to the touch, sometimes resembling a bump or lump.
• Evolution over time: Hemangiomas tend to change as they age. They might become thicker and develop a different color, often lightening to match the surrounding skin.
• Potential for ulceration: In certain situations, mainly in areas subject to friction, hemangiomas can develop sores or crusts, potentially leading to bleeding or infection.
• Discomfort or pain: Hemangiomas can cause discomfort or tenderness, especially if they become ulcerated or affect deeper tissues.
• Functional impact: Depending on their size and location, hemangiomas can interfere with the normal function of the affected area. For example, a hemangioma near the eye could obstruct vision.
• Emotional and social effects: Hemangiomas on visible body parts, like the face, may lead to emotional distress or self-esteem issues, especially in older children and adults.
• Possible complications: While rare, hemangiomas can lead to complications, including ulceration, bleeding, or, in large or deep hemangiomas, the potential to affect nearby structures or organs.

There are no specific preventive measures to thwart the spontaneous appearance of hemangiomas in children. These growths often emerge unpredictably during fetal development and early infancy. But there are some ways to decrease the probability of occurrence of hemangiomas in your child, such as: 

• Prioritize prenatal health: While hemangiomas are not directly preventable, prioritizing a healthy pregnancy through regular prenatal check-ups and adherence to healthcare provider guidance is paramount, as it supports overall fetal well-being.
• Awareness of risk factors: Being aware of potential risk factors, such as premature birth or a family history of hemangiomas, can provide insight into the child's predisposition to the condition. However, these factors are beyond direct control.
• Early identification and consultation: Timely detection of a hemangioma is crucial. Parents should promptly seek medical consultation if they notice unusual skin growths or changes in their child's skin during the early weeks and months of life.
• Individualized medical guidance: Consulting with a pediatrician or dermatologist for tailored advice and management strategies is essential. Each child's case is unique, and healthcare providers can offer personalized recommendations.
• Vigilant monitoring: Maintaining vigilance by closely monitoring the child's skin for any developments, especially if risk factors are present, can aid in early intervention if a hemangioma does emerge.
• Genetic counseling: For parents with a family history of hemangiomas, seeking counsel from a congenital expert or healthcare provider can provide a deeper understanding of potential risks and guidance on managing concerns.

Your doctor may diagnose hemangiomas through a combination of various methods, including but not limited to:

• Clinical examination: Diagnosis often begins with a thorough clinical examination by a healthcare provider, who observes the physical characteristics of the skin lesion. Hemangiomas have a distinctive appearance, such as raised, red, or bluish patches on the skin.
• Medical history: The healthcare provider will also take a detailed medical history, including any family history of hemangiomas or other vascular anomalies, as this information can aid in the diagnosis.
• Physical assessment: To assess the size, location, and potential complications of the hemangioma, the healthcare provider may perform a physical assessment, examining the surrounding tissues and any functional impairments caused by the growth.
• Imaging Studies: In some cases, imaging studies such as ultrasound, MRI (Magnetic Resonance Imaging), or CT (Computed Tomography) scans may provide better results. These tests can give a deeper view of the hemangioma, mainly if they are in deeper tissues or organs.
• Dermoscopy: Dermoscopy, a non-invasive technique, may be used to closely examine the surface features of the hemangioma, aiding in the differentiation from other skin conditions.
• Biopsy (rarely): A biopsy, although rarely needed, involves taking a small sample of the hemangioma tissue for laboratory analysis. Your doctor may consider it in atypical cases or when they need to rule out other conditions.
• Photographs and documentation: The doctors may need serial pictures to document the size, color, and changes in the hemangioma over time. It helps in monitoring its progress and response to treatment.
• Consultation with specialists: Depending on the location and potential complications, healthcare providers may refer patients to dermatologists, pediatric surgeons, or ophthalmologists for further evaluation and management.
• Monitoring over time: As hemangiomas can change in size, color, and texture as they evolve, ongoing monitoring by a healthcare provider is essential to assess any developments and ensure appropriate management.

The doctors usually classify hemangiomas into different stages based on their growth and regression. It is not necessary that all the hemangiomas follow the same sequence of steps. These stages can be:

• Proliferative (growth) phase: In the initial stage of hemangioma development, known as the proliferative Phase, the lesion is rapidly growing. This Phase is characterized by a noticeable increase in the size and prominence of the hemangioma, typically occurring in the first few weeks to months after birth.
• Plateau (stable) phase: Following the initial growth, most hemangiomas enter a plateau or stable Phase. The hemangioma remains relatively unchanged in size, color, and texture during this stage. The plateau phase can last for varying durations, ranging from several months to a few years.
• Involution (regression) phase: The involution phase marks the hemangioma's spontaneous shrinking and gradual disappearance. It typically commences around the child's first year of life, although the exact timing may differ. As the hemangioma involutes, it becomes softer, less raised, and changes color, often fading to a more natural skin tone.
• Residual phase (if applicable): Sometimes, a residual phase may follow the involution phase. During this stage, a small amount of residual tissue or discoloration may persist after the regressed hemangioma. The duration of the residual Phase can vary, lasting for months or even years, and in some instances, it may require medical or surgical intervention for cosmetic or functional reasons.

In most cases, hemangiomas in your child do not require treatment and will go away over time. However, some hemangiomas may require treatment if they are causing problems, such as bleeding, pain, or vision problems. Some of the ways to treat and manage hemangiomas are:

• Observation and monitoring: In many cases, healthcare providers may adopt a strategy of "watchful waiting," closely monitoring the hemangioma's progress to determine if intervention is necessary. This approach is often taken during the initial proliferative Phase when rapid growth occurs.
• Topical medications: Medications like timolol gel or ointment are effective on some superficial hemangiomas. These medications may reduce the size and color of the lesion by constricting blood vessels within the hemangioma.
• Oral medications: In certain situations, the doctor may prescribe oral medications like propranolol. Propranolol is a beta-blocker that can help shrink hemangiomas and are effective for large or problematic hemangiomas.
• Pulsed-dye Laser therapy: Laser therapy, often using a pulsed-dye laser, can effectively treat superficial hemangiomas by targeting the blood vessels within the lesion. This non-invasive approach can help improve the appearance of the hemangioma.
• Corticosteroids: Corticosteroids can be administered orally or through intralesional injections for large hemangiomas or those that threaten vital functions. These medications work to reduce inflammation and suppress abnormal blood vessel growth.
• Interferon: In severe cases where other treatments are ineffective, interferon-alpha may work. However, doctors use them cautiously due to potential side effects.
• Surgical removal: Surgical removal may be recommended for ulcerated hemangiomas, causing significant functional impairment or if other treatment measures have failed. It involves excising the lesion and may be followed by reconstructive surgery if necessary.
• Compression garments: Elastic compression garments can manage hemangiomas in certain areas, such as the extremities. These garments apply gentle pressure to help reduce swelling and promote flattening of the lesion.
• Psychosocial support: Managing the psychosocial impact of hemangiomas is crucial, especially for children with visible lesions. Counseling and support can help children and families cope with emotional and self-esteem issues.
• Multidisciplinary approach: Given the diverse nature of hemangiomas and potential complications, an interdisciplinary approach involving pediatricians, dermatologists, plastic surgeons, and other specialists may be necessary to provide comprehensive care and tailor treatment to the individual patient's needs.

In the majority of cases, the prognosis for hemangiomas is favorable. Many hemangiomas naturally regress and resolve independently over time without causing significant issues.

• Age-dependent progression: The prognosis can be age-dependent. While hemangiomas may appear alarming during infancy due to their rapid growth, they often stabilize and spontaneously regress during childhood.
• Potential for complications: While most hemangiomas do not lead to complications, factors such as location (especially near vital organs or the airway), size, or ulceration can increase the risk of complications.
• Functional impact: Hemangiomas in critical areas like the eye, nose, or throat can affect vision, breathing, or other functions. The prognosis may vary depending on the functional implications.
• Cosmetic concerns: Hemangiomas on the face or other visible areas can have cosmetic implications, potentially impacting self-esteem. However, with appropriate treatment and management, you can eliminate these concerns.
• Residual changes: Even after involution, some hemangiomas may leave behind residual changes such as discoloration, scarring, or tissue irregularities. These residual effects can vary but are generally manageable.
• Psychosocial impact: Hemangiomas can have a psychosocial impact, especially as children grow older and become more aware of their appearance. It may necessitate psychosocial support to address emotional and self-esteem issues.
• Multidisciplinary approach: A multidisciplinary approach, involving healthcare providers from various specialties, can optimize the prognosis. Coordinated care ensures that all medical, surgical, and psychological aspects.
• Early intervention: Early detection and timely intervention, when necessary, can significantly improve the prognosis, prevent complications, and mitigate long-term effects.
• Continued monitoring: Even after the involution of hemangiomas, healthcare providers may recommend continued monitoring to assess potential long-term effects, including cosmetic and functional aspects.

What is a hemangioma?
A hemangioma is a benign tumor made up of blood vessels.

How common are hemangiomas in infants?
Hemangiomas are the most common type of tumor in infants, affecting up to 10% of newborns.

Can hemangiomas occur in adults?
While rare, hemangiomas can develop in adults, although they are most common in infants and young children.

Are hemangiomas cancerous?
Hemangiomas are benign (noncancerous) tumors.

What causes hemangiomas?
The exact cause is not fully understood, but it may be due to abnormal blood vessel development during fetal growth.

Are there different types of hemangiomas?
There are various types, including infantile, congenital, deep, and segmental hemangiomas.

What is the most common type of hemangioma?
Infantile hemangiomas are the most common type, accounting for about 80% of cases.

What is the prevalence of hemangiomas in India?
Hemangiomas are more common in India than in other parts of the world, with a prevalence of 4.3% in newborns.

How do I know if my child has a hemangioma?
A healthcare provider can diagnose a hemangioma through a physical examination and medical history.

Are hemangiomas painful?
Hemangiomas are typically not painful unless they ulcerate or affect deeper tissues.

Do all hemangiomas need treatment?
Many hemangiomas do not require treatment and naturally regress over time.

Can hemangiomas be treated with medication?
Medications like propranolol or corticosteroids can manage hemangiomas.

What is the role of laser therapy in treating hemangiomas?
Laser therapy can target and shrink superficial hemangiomas by focusing on the blood vessels within the lesion.

When should I seek medical treatment for a hemangioma?
You may seek medical treatment if the hemangioma is causing functional issues, ulceration, or other complications.

What is the appropriate age to begin treatment for a hemangioma?
Treatment timing depends on the hemangioma's characteristics and potential complications. It can begin at any age, including infancy or later childhood.

Can hemangiomas be surgically removed?
Surgical removal is an option for certain hemangiomas, especially if they are large, deep, or causing significant problems.

Are there any risks associated with surgical removal of hemangiomas?
Surgery carries some risks, including scarring and the need for anesthesia. However, your doctor weighs these risks against the benefits.

What is the role of the Department of Vascular Surgery in hemangioma treatment?
The Department of Vascular Surgery specializes in treating vascular anomalies like hemangiomas, offering expertise in surgical and minimally invasive techniques.

How long does it take for a hemangioma to involute (shrink)?
The involution phase typically begins around one year of age and can continue for several years, gradually reducing the hemangioma's size.

Can hemangiomas leave behind permanent effects or scarring?
In some cases, hemangiomas may leave behind residual changes, such as discoloration or scarring, even after involution.

Do hemangiomas always require medical attention?
Many hemangiomas do not require medical intervention and may need monitoring over time.

Can hemangiomas reappear after regression?
Once a hemangioma has involuted completely, it typically does not reappear.

Can hemangiomas cause vision problems if located near the eye?
Hemangiomas near the eye can affect vision and may require early intervention.

Is it possible to prevent hemangiomas in infants?
Hemangiomas are generally not preventable as they often develop spontaneously.

Are there any known risk factors for hemangiomas?
Risk factors may include gender (more common in females), premature birth, and family history of hemangiomas.

What is the significance of prematurity as a risk factor for hemangiomas?
Premature infants are more likely to develop hemangiomas, possibly due to underdeveloped blood vessels.

Can hemangiomas be hereditary?
Some evidence suggests a genetic predisposition in families with a history of hemangiomas.

Are multiple births associated with an increased risk of hemangiomas?
Infants born as part of multiple births (twins, triplets) may have a slightly higher risk of developing hemangiomas.

What role does genetics play in the development of hemangiomas?
Genetics may contribute to the development of hemangiomas, with specific genetic mutations identified in some cases.

Are there any non-invasive diagnostic tests for hemangiomas?
Diagnostic tools like ultrasound and MRI can provide non-invasive imaging of hemangiomas.

What is dermoscopy, and how is it used in hemangioma diagnosis?
Dermoscopy is a non-invasive technique that closely examines the surface features of hemangiomas to aid in diagnosis.

Why might a biopsy be performed for a hemangioma?
Biopsies are rarely needed but are advisable in atypical cases or when doctors may rule out other conditions.

What is the most common location for hemangiomas?
Hemangiomas can occur anywhere on the body but are most common on the face, scalp, and neck.

Can hemangiomas affect deeper tissues or organs?
Deep hemangiomas can affect tissues like muscles or organs, making them more challenging to treat.

What are the stages of hemangiomas?
Hemangiomas progress through proliferative, plateau, involution, and, if applicable, residual phases.

Is it possible for hemangiomas to become painful?
Hemangiomas are typically not painful unless they ulcerate or affect deeper tissues.

What is the cosmetic impact of hemangiomas?
Hemangiomas on visible areas like the face can have a cosmetic impact, potentially affecting self-esteem.

Can hemangiomas lead to functional problems?
Hemangiomas located near vital organs or airways can cause functional issues.

Can hemangiomas affect a child's psychological well-being?
Hemangiomas can have psychosocial effects, especially as children become more aware of their appearance.

What is the role of psychological support in hemangioma management?
Psychological support can help children and families cope with the emotional impact of hemangiomas.

Is there a cure for hemangiomas?
Hemangiomas often resolve on their own, but there is no specific cure.

What is the primary goal of hemangioma treatment?
The primary goal is to manage complications, improve function, and optimize appearance when necessary.

Are all hemangiomas treated the same way?
Treatment approaches vary based on factors like type, location, and size of the hemangioma.

Can hemangiomas be left untreated?
Many hemangiomas do not require treatment and require regular monitoring.

What is the best age to start treating a hemangioma?
The age for starting treatment varies based on the hemangioma's characteristics and potential complications.

How do healthcare providers determine the appropriate treatment for a hemangioma?Treatment decisions depend on the hemangioma's type, location, size, and stage.

Can hemangiomas spontaneously resolve without treatment?
Many hemangiomas naturally regress without medical intervention.

Is it necessary to remove a hemangioma if it doesn't cause complications?
If a hemangioma is not causing problems, it may not require removal.

What is the risk of complications during hemangioma removal surgery?
Surgical risks may include scarring and the use of anesthesia, but these are carefully assessed and balanced against the benefits.

Can hemangiomas return after surgical removal?
Once the doctor has surgically removed the hemangioma, it typically does not return.

Is it possible for a hemangioma to interfere with vital functions?
Hemangiomas located near vital organs or airways can interfere with essential functions.

What is the significance of the involution phase in hemangiomas?
The involution phase marks the natural shrinking and gradual disappearance of the hemangioma.

Can hemangiomas leave behind permanent effects or scarring?
Some hemangiomas may leave residual changes like discoloration or scarring, even after involution.

Is it possible to prevent hemangiomas in infants?
Hemangiomas are generally not preventable as they often develop spontaneously.

What is the significance of prematurity as a risk factor for hemangiomas?
Premature infants are more likely to develop hemangiomas, possibly due to underdeveloped blood vessels.

Can hemangiomas be hereditary?
Some evidence suggests a genetic predisposition in families with a history of hemangiomas.

Are multiple births associated with an increased risk of hemangiomas?
Infants born as part of multiple births (twins, triplets) may have a slightly higher risk of developing hemangiomas.

What is the most common location for hemangiomas?
Hemangiomas can occur anywhere on the body but are most common on the face, scalp, and neck.

What is the cosmetic impact of hemangiomas?
Hemangiomas on visible areas like the face can have a cosmetic impact, potentially affecting self-esteem.

Can hemangiomas affect a child's psychological well-being?
Hemangiomas can have psychosocial effects, especially as children become more aware of their appearance.

What is the role of psychological support in hemangioma management?
Psychological support can help children and families cope with the emotional impact of hemangiomas.

What is the primary goal of hemangioma treatment?
The primary goal is to manage complications, improve function, and optimize appearance when necessary.

Are all hemangiomas treated the same way?
Treatment approaches vary based on factors like type, location, and size of the hemangioma.

What is the role of compression garments in hemangioma management?
Compression garments apply gentle pressure to help reduce swelling and promote flattening of hemangiomas.

What is the best age to start treating a hemangioma?
The age for starting treatment varies based on the hemangioma's characteristics and potential complications.

How do healthcare providers determine the appropriate treatment for a hemangioma?Treatment decisions depend on factors such as the type, location, size, and stage of the hemangioma.

What is the risk of complications during hemangioma removal surgery?
Surgical risks may include scarring and the use of anesthesia, but these are carefully assessed and balanced against the benefits.