Hemangioma: Meaning, Causes, Symptoms, Treatment

Written by Medicover Team and Medically Reviewed by Dr Purva Shripal Jain , pediatrician

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A hemangioma is a non-cancerous or benign growth of blood vessels that appears as a red or purple mark on the skin or inside the body. It is called a birthmark because it usually develops in infancy. Hemangiomas are the most common type of vascular tumor in children and affect up to 10% of infants.

Most hemangiomas are harmless and may shrink or disappear with age but some can grow larger and cause pain or affect vital organs depending on their location. In such cases, treatment may be needed to prevent complications.

Types of Hemangioma

Hemangiomas are grouped into different types depending on how deep they are and how they appear on the body. Each type has its own unique look and growth pattern.

Superficial Hemangioma

These are the most visible and appear on the surface of the skin as bright red, raised patches. Because of their color and texture, they are called strawberry hemangiomas. They are usually harmless and may fade as the child grows.

Deep Hemangioma

These occur under the skin and may look bluish or swollen. They are not as visible on the surface as superficial ones but can cause a lump-like appearance. Some deep hemangiomas may press on nearby tissues and need medical monitoring.

Mixed Hemangioma

This type combines features of both superficial and deep hemangiomas. A child may have a visible red mark on the skin surface along with deeper tissue involvement beneath it.

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Classification of Hemangioma

Apart from depth and appearance, hemangiomas are also classified based on how and when they develop as well as the type of blood vessels involved.

Infantile Hemangioma

It is the most common form and usually appears within the first few weeks of life. These grow quickly in the first year (growth phase) and then slowly shrink over time (involution phase). Many completely disappear by early childhood.

Congenital Hemangioma

These are fully formed at birth, unlike infantile hemangiomas which develop after birth. They are of two types:

• Rapidly Involuting Congenital Hemangioma (RICH): It shrinks quickly during the first year of life.
• Non-Involuting Congenital Hemangioma (NICH): It does not shrink and remains throughout life, although it may become smaller in size as the child grows.

Cavernous Hemangioma

Formed by larger blood vessels, these hemangiomas usually occur in deeper tissues. They may appear in organs such as the liver, brain or kidneys and sometimes need medical imaging for detection.

Capillary Hemangioma

This type is made up of small capillary blood vessels, which occur on the skin, lips or inside the mouth. They appear as flat or slightly raised red marks and are among the most common forms in infants.

What are the Signs and Symptoms of Hemangioma?

The signs of a hemangioma depend on where it appears, its size and whether it affects only the skin or deeper tissues. Most hemangiomas are noticeable in infancy and grow quickly during the first year of life before stabilising or shrinking. Here are some common symptoms:

• Visible skin marks: Red, purple or bluish patches that may be flat at first and later become raised. These are called as strawberry marks.
• Quick growth phase: Many hemangiomas enlarge quickly during the first few months of life, sometimes doubling in size.
• Swelling or raised surface: The skin over the affected area may appear stretched or swollen.
• Pain or tenderness: Deeper hemangiomas can sometimes cause discomfort if they press on nearby tissues.
• Skin breakdown: In rare cases, the overlying skin may ulcerate, which causes pain and increases the risk of infection.
• Internal symptoms: When hemangiomas grow inside the body like in the liver or airway, they may lead to organ-related problems like abdominal swelling, breathing difficulties or feeding issues.

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What are the Causes of Hemangioma?

The exact cause of hemangiomas is still not completely known but researchers believe a combination of biological and genetic factors is responsible for the condition.

• Abnormal blood vessel growth: Hemangiomas form when tiny blood vessels grow and multiply more than they should and create a cluster that develops into a lump.
• Genetic influence: A family history of vascular anomalies may increase the likelihood of a child developing hemangiomas, although most cases occur randomly.
• Prematurity and low birth weight: Babies born early or with low birth weight have a higher risk of developing hemangiomas.
• Gender factor: Hemangiomas are more common in females than in males, suggesting that hormones may be responsible.
• Hormonal and environmental factors: Some hormones or changes in the womb during pregnancy may influence the abnormal development of blood vessels.

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What are the Side Effects or Complications of Hemangioma?

Most hemangiomas are mild, painless and fade naturally over time. They can sometimes lead to complications that require medical care IF they grow larger or appear in sensitive areas.

• Ulceration and bleeding on the skin.
• Vision problems if located near the eyes.
• Breathing difficulties if present in the airway.
• Pain and functional issues if affecting internal organs like the liver.
• Cosmetic concerns that affect self-confidence.

When to See a Doctor

You should consult a doctor if:

• The hemangioma grows rapidly or looks unusual.
• It bleeds, ulcerates or becomes painful.
• It is located near vital areas like the eyes, nose, mouth or airway.
• Multiple hemangiomas appear on the body.
• Internal symptoms such as abdominal swelling, headaches or seizures.

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How to Diagnose Hemangioma?

Most hemangiomas can be identified by their appearance on the skin during a routine physical examination. Doctors can recognise them easily because of their distinct color and growth pattern. Here are some effective diagnostic methods for hemangioma:

• Physical Examination: The first step is a visual and physical check by the doctor to determine the type, size and location of the hemangioma.
• Ultrasound: A safe and painless imaging test that uses sound waves to evaluate the depth of the hemangioma, its size and the flow of blood within it.
• MRI or CT scan: These advanced imaging techniques are recommended if doctors suspect deeper hemangiomas affecting internal organs such as the liver, kidneys or brain. They provide detailed images to guide treatment.
• Hemangioma radiology: Specialised imaging studies help doctors map the exact structure of the blood vessels inside the lesion, which is important for planning treatment in complex cases.

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Effective Treatment for Hemangioma

It is important to know that not every hemangioma requires treatment. In fact, many infantile hemangiomas shrink naturally over time without causing any long-term problems. But in some cases, medical treatment is required to avoid future complications and effective treatments are:

Observation

Small and uncomplicated hemangiomas are closely monitored with regular check-ups. Parents are reassured and advised to watch for any sudden changes.

Hemangioma Medicines

• Beta-blockers or Propranolol are considered the most effective treatment for shrinking infantile hemangiomas. They reduce blood flow to the lesion to soften and shrink it.
• Corticosteroids may be prescribed in cases where beta-blockers cannot be used. They slow down the growth of blood vessels.

Laser therapy

A non-invasive option that uses focused light to reduce redness, shrink superficial lesions and heal ulcerated areas.

Hemangioma Surgery

Performed in rare cases when the hemangioma is very large and causes severe complications or does not respond to other treatments. Surgery may also be considered for cosmetic reasons after the lesion has stopped growing.

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Prognosis of Hemangioma

The outlook for children and adults with hemangiomas is generally excellent. Most infantile hemangiomas follow a natural course:

• They grow rapidly during the first year of life.
• Growth slows down and the hemangioma gradually shrinks and fades over the next several years.
• By the age of 5 to 10 years, many hemangiomas have either disappeared completely or become much less noticeable.

Internal hemangiomas like those in the liver, also remain stable and do not cause long-term health problems, though regular monitoring may be recommended.

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Conclusion

Hemangiomas are common, benign vascular growths that resolve on their own. Most do not require treatment but some may need treatment if they grow rapidly, cause complications or affect important organs. With advances in medical therapy and imaging techniques, hemangiomas can be effectively managed and improve health outcomes.

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