Infantile Hemangiomas
Modern Therapeutic Approaches
Definition
Hemangiomas are the most common benign tumors of infancy. They are vascular lesions of the subcutaneous tissue caused by excessive proliferation of cutaneous blood vessels. They develop shortly after birth, increase in size during the first few months of life, and gradually begin to regress.
They may appear anywhere on the body, red or bluish in color, and consist of dysplastic vessels with structural and functional abnormalities. Due to their appearance, they are often referred to as “strawberry hemangiomas”.
They usually become visible between the 3rd and 5th week of life, while at birth they may not be noticeable or may present as mild redness (telangiectasia). In 50% of cases, they disappear by the age of 5, and in 70% by age 7. However, a small scar or mark may persist at the site of the hemangioma.
- Specialized, highly experienced medical team
• Early diagnosis and timely treatment
• Combination of modern and effective methods
• Safe resolution without scarring
Types of Hemangiomas
Hemangiomas are classified into three main categories based on their depth within the skin:
• Superficial: Located close to the surface of the skin and more visibly apparent.
• Deep: Extend deeper into the dermis, with less prominent external features.
• Mixed: Exhibit both superficial and deep components.
Etiology
Hemangiomas are more commonly observed in:
• Premature infants
• Girls
• Infants from multiple pregnancies
• Infants born to older mothers, or mothers with a history of preeclampsia or placenta previa
Symptoms
They appear as raised red or purple-colored masses, depending on their depth. They are soft to the touch and painless unless ulceration occurs. They are most commonly located on the head and neck (60%), but may also appear on the trunk (25%) and extremities (15%).
In some cases, they may be found in internal organs, such as the liver. Approximately 20% of infants may present with multiple hemangiomas.
Their course includes four phases: rapid growth during the first six months, stabilization during the second half of the first year, involution beginning in the second year and lasting up to five years, and the post-involution phase, which begins after the age of five.
During this final phase, hemangiomas may fully disappear or leave behind telangiectasias, atrophy, residual tissue, or skin discoloration.
They typically reach their maximum size around the first year of life. By age 3, 30% of hemangiomas regress, 50% by age 5, and 70–90% by age 7.
Potential Complications of Hemangiomas
In some cases, hemangiomas may interfere with vital functions. For example, a lesion near the eye may impair vision. There is also a risk of bleeding or infection. The psychological burden on both the child and the parents should not be underestimated.
When Treatment Is Necessary
Main indications for treatment include:
• Aesthetic or functional impairment
• Presence of ulceration or skin atrophy
• Airway obstruction affecting breathing
• Hearing or visual disturbances
• Increased risk of bleeding from trauma
• Psychosocial or educational difficulties due to social stigma
• Skeletal deformity
Therapeutic Approaches
Modern surgical techniques, in combination with advanced laser technologies and pharmacologic therapies, provide effective options for the treatment of hemangiomas.
Surgical Treatment
Surgical excision is preferred before the age of 12 months, as removal is easier and wound healing is more effective in young infants. Successful surgical outcomes can also be achieved in older children, often with similarly satisfactory results.
Advanced Laser Treatment
True hemangiomas are often treated effectively with innovative laser technology, with or without adjunctive pharmacologic therapy, depending on individual case needs.
Laser technology targets the lesion precisely, sparing the surrounding healthy skin. The method is safe, painless, and free of side effects, and does not leave scarring. In many cases, visible results can be achieved from the very first session.
In 96% of cases, laser treatment halts further growth of the hemangioma. Many regress completely, others shrink significantly, and in numerous cases, more than 50% improvement is observed.
Pharmacologic Therapy
Traditionally, medications such as corticosteroids, vincristine, and interferon were used. Today, propranolol, a beta-blocker originally used for cardiovascular conditions, has become a cornerstone of conservative management. Its mechanism includes vasoconstriction, inhibition of angiogenesis, and promotion of apoptosis (programmed cell death) in the lesion.
Before initiating propranolol therapy, a pediatric cardiologist assessment is mandatory, including blood pressure measurement, ECG, and cardiac ultrasound. Blood glucose must also be monitored to prevent hypoglycemia.
The treatment is administered orally, with gradual dose escalation, and continues until the hemangioma regresses, followed by tapering of the medication. For infants under 2 months of age, hospitalization is recommended at the start of treatment.
The expertise and experience of the dermatologists at Optimum Dermatology ensure treatment success even in newborns as young as 2 weeks old, with no scars or permanent marks. Early intervention reduces risks and prevents complications from vascular lesions.
Effective and safe restoration—both aesthetic and functional—is achieved through a multidisciplinary approach, combining medical expertise, pharmacotherapy, laser treatment, and surgery.