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Hemangiomas

What is a hemangioma?

A hemangioma (hee-man-jee-OH-muh) is a type of birthmark, which is an abnormal place on a baby’s skin that is present at birth. Hemangiomas are in a category called vascular birthmarks, made up of blood vessels that did not form normally. They are sometimes called “strawberry marks.”

A hemangioma can be visible at birth. This type is called congenital hemangioma, and it is rare. Another type of hemangioma, called infantile hemangioma (IH), usually only becomes visible starting in the first month after birth. Sometimes at birth, there may be a pale area, resembling a bump or scratch, that later turns out to be an infantile hemangioma. They are very common, affecting somewhere between 4% to 5% of all births.

About infantile hemangiomas

Infantile hemangiomas can occur anywhere on the body, but most of them, about 60%, are on the head/face and neck. They are usually not painful.

They have a rapid growth phase during the first three months of a baby’s life and then continue to grow more slowly for the next five to eight months. Despite this growth in size, hemangiomas are not cancerous.

Infantile hemangiomas typically stop growing when a baby is around 12-18 months old, but do not go away immediately. Eventually, they begin to shrink and flatten from the middle and will go away on their own over a period of several years. Most of the time, a hemangioma has cleared up by the time a child is 5 years old. The skin will usually look normal, but there may be some lasting changes, such as loose skin where the hemangioma was.

In general, about half of infantile hemangiomas are gone in 5 years, about 70% are cleared in 7 years, and around 90% by 9 years. The ones that take the longest to go away are more likely to leave changes on the skin.

Commonly, a baby has only one hemangioma, but sometimes there can be several in different places, or a scattering of them over a larger area that resembles a rash. They can be right on top of the skin, beneath the skin or a mixture of both. A single hemangioma on top of the skin usually looks like a red lump. The ones beneath the skin look like bluish lumps, almost like a raised bruise.

Rarely, sores can develop on hemangiomas and cause bleeding. This condition, called ulceration, can lead to infections.

What causes infantile hemangioma?

Hemangiomas form because of an abnormality that causes small blood vessels to clump together. Experts don’t fully understand why this occurs, but hemangiomas are more likely to happen in babies who are:

• Female
• White
• Low birth weight
• Born prematurely

There may also be a family tendency for these birthmarks, a link to older age in the baby’s mother, and to being a twin or triplet.

How are infantile hemangiomas diagnosed?

Usually, a doctor can diagnose an infantile hemangioma during a good physical exam and discussion with the baby’s parents/guardians. There are a few types of birthmarks that have similarities to infantile hemangiomas, so physicians have to rule out other possibilities. Some of these include:

• Port wine stain (capillary malformation)
• Pyogenic granuloma
• Venous malformation
• Arteriovenous malformation
• Macrocystic lymphatic malformation
• Other tumors

Although it is rarely necessary, there are tests that can be performed on a sample of skin tissue (a biopsy) to confirm the diagnosis.

Because of the way infantile hemangiomas go through such a rapid growth phase, it’s important to get the diagnosis early. Although most will never cause a problem and will go away on their own, certain ones need treatment. The earlier the treatment begins, the better the results.

The size, type, number and location of the infantile hemangioma(s) help doctors determine if it fits into a category where treatment is recommended. Rarely, some infantile hemangiomas may be associated with other internal problems. For one with these traits, doctors may order imaging tests such as ultrasound or MRI.

The types of infantile hemangiomas that may need treatment generally include those that could:

• Interfere with functions such as seeing, eating, breathing or hearing
• Develop a breakdown in the skin, called ulceration
• Cause permanent skin changes, such as the texture or color of the skin, especially in areas that are easily seen, such as the face

How are infantile hemangiomas treated?

Uncomplicated infantile hemangiomas that are small and don’t go very deep into the skin may not need treatment. These usually go away on their own over time. Even without treatment, some physicians will want to see the baby often, especially early on when the hemangioma is in the rapid growth phase. They may take pictures to compare how it looks from previous visits.

Fortunately, when treatment may be needed, there are a number of good options available. Results are better when treatment begins as soon as possible. Ideally, this would be within the first month of the baby’s life during the rapid growth phase.

Most infantile hemangiomas that need treatment can be managed with medications. Some types of medicine, called topical medications, are applied directly onto the hemangioma. Topical medications are most often used for smaller hemangiomas that aren’t deep.

For some infantile hemangiomas, doctors may prescribe medications that have to be swallowed. The most common of these is called propranolol. It has a very good track record, especially when started early. A baby may need to stay on the medication for about a year. It can have mild, manageable side effects, so it’s important to use it as prescribed and to keep up with all office appointments.

Sometimes, physicians may use lasers to treat hemangiomas, especially ones that have ulceration. Laser treatment may help stop bleeding and promote healing for the places where the skin is raw and open. Also, after a hemangioma has gone away, laser treatment may be used to improve the color and texture of skin if the hemangioma left a permanent mark.

There are some instances where surgery may be considered to treat a hemangioma:

• A small number of hemangiomas don’t respond to medications.
• Early on, when it is in its rapid growth phase, a hemangioma could grow into an area where it interferes with the development of important structures. For example, one near the eye could cause vision problems. In cases like this, physicians may want to remove the hemangioma to prevent complications.

Surgery usually isn’t the first choice, though, since there are good medications that work very well in most cases. But if surgery is needed, it’s better to do it before any long-lasting problems develop. Sometimes, surgery may also be needed to repair skin after a hemangioma has cleared up. This type of surgery may be delayed until the baby is between 3 and 5 years old.

Rarely, surgery may have to be done as an emergency if the hemangioma is located where it threatens vital functions, such as breathing.

What is the outlook for infantile hemangiomas?

Most infantile hemangiomas go away on their own and never cause a problem. When treatment is needed, the earlier it begins the better the results.

Occasionally, a hemangioma that has been treated with medication will start to grow back. Experts don’t understand why this happens, but it seems to be more likely when the baby is a girl and when the hemangioma is deep. If this regrowth occurs, there are other treatments physicians can use if needed. In only about 8% of babies, the infantile hemangioma leaves a mark that needs surgery to repair.

Get help at Children’s of Mississippi.

The pediatric plastic surgeons at Children’s of Mississippi are experts in evaluating, treating and repairing infantile hemangiomas. We have all the pediatric specialists who may be needed for expert care, including dermatologists, ophthalmologists, pulmonologists and others. Working together, our pediatric experts help babies with infantile hemangiomas have their best possible results.

If your child has an infantile hemangioma, you can schedule an appointment with our Children’s of Mississippi plastic surgery team. They can answer your questions and help you understand the options for your child. Schedule an appointment online.

Last reviewed: 08/21/2026