From the real experts at Hassenfield Children’s Hospital at NYU Langone:
More babies than not are born with some sort of birthmark, and while many fade, some are here to stay. Birthmarks come in all shapes, colors, and sizes. Most of them are fine to leave alone, but there are a few kinds that can become problematic. For parents, it’s important to know which birthmarks are abnormal and should be seen by a physician.
What Are Vascular Birthmarks?
Vascular birthmarks fall under the category of vascular anomalies, which are the result of abnormal blood or lymphatic vessels. They can present anywhere on the body, including the skin, the scalp, on the inside of the mouth, or on the genitalia. They can also be present in internal organs. Depending on the vessel type, vascular birthmarks can vary in color from pink or red, to blue, purple, or gray. Some vascular birthmarks are close enough to the surface of the skin to be seen and/or felt immediately after birth, but others don’t appear until later in infancy or childhood.
What Are the Most Common Vascular Birthmarks?
Infantile hemangiomas and capillary malformations are the most common vascular birthmarks. Both are on the skin’s surface, or typically close enough to the surface to be noticed before a baby is one month old, and tend to be pink, red, or purple.
Infantile hemangiomas are the most common vascular birthmarks. They are commonly called “strawberry angiomas,” because they often look attached to the skin’s surface, and protrude in small, clustered red bumps. Parents tend to say that the marks started as a single, small, red spot right at birth.
Hemangiomas can also be on the flatter side, or located deep to the skin. When deep, they might look like a tinted, smooth protrusion of skin. Shortly after birth, they begin to grow rapidly; during this period, they usually darken and turn from red to purplish.
Infantile hemangiomas grow at their fastest rate when babies are around seven months old. By one year, they begin to shrink. One of the first signs of shrinkage is lightening of the involved skin to gray, which usually begins in the center of the hemangioma. The gray skin is a sign that the blood vessels are being replaced by fatty tissue, which may or may not be noticeable, depending on how big or how deep the infantile hemangioma was.
By age two, infantile hemangiomas usually go away on their own, leaving only a faint mark, if anything. This is why most infantile hemangiomas can be observed as your baby grows, and don’t require any medicine or surgery.
Which Infantile Hemangiomas Need Treatment?
If infantile hemangiomas grow too quickly or get too large, complications can arise. Rapid growth can lead to ulceration, forming cracks in the skin and bleeding. This can lead to infection and scarring.
The size of infantile hemangiomas can also become problematic when they compress or cover surrounding structures. For example, an infantile hemangioma blocking a nostril, or one causing an eyelid to droop and block vision, requires action from your doctor.
Very large infantile hemangiomas can also become aesthetically unappealing, especially if they are located on the face. Even though the birthmark most often goes away on its own, large infantile hemangiomas can leave behind some fatty tissue and distended skin when they fade. This left-behind skin has a pale, saggy appearance. Typically, the larger infantile hemangiomas are allowed to grow, the more saggy tissue they will leave behind.
The birthmark location is also important because it may signify a disorder in the underlying tissues or organs. For example, infantile hemangiomas under or around the chin might indicate that there are infantile hemangiomas in the mucosa of the upper airway, which can lead to breathing problems. If your pediatrician suspects internal organ involvement, your baby may need an airway evaluation by an airway specialist, or an MRI, which is a special imaging study that helps evaluate deep effects of vascular anomalies.
Besides size and location, the number of infantile hemangiomas can also be concerning. In particular, if a patient has more than five separate hemangiomas, that could indicate vascular anomalies of the liver. Make sure to tell your doctor if your baby has multiple infantile hemangiomas, so that imaging tests to check the liver and other internal organs can be ordered, if necessary.
If your baby’s hemangioma is changing and showing some concerning signs, you should see a vascular anomalies specialist—a pediatrician, dermatologist, or surgeon who has spent time dedicated to learning about the spectrum of vascular anomalies, and how to treat them. This specialist will take into account the factors discussed above, and help guide you towards further observation of the infantile hemangioma, or towards a treatment plan. He or she may want you to see a subspecialist, like an otolaryngologist, ophthalmologist, orthopedist, etc, for an opinion about the area potentially affected by the hemangioma.
After evaluating your baby’s infantile hemangioma, your doctor may encourage you to intervene to halt its growth. Treatment options for infantile hemangiomas can be divided into three main groups:
- Medical Therapy – Several medications exist that have been shown to help slow or halt hemangioma growth, and in some cases, speed up the regression process.
- Laser Therapy – There are advanced medical lasers that can be used to shrink the blood vessels specific to infantile hemangiomas.
- Surgical Therapy – Occasionally, removing the hemangioma is the best option. This is usually a decision that is made when it is evident that the hemangioma will cause functional, developmental, or aesthetic problems if left alone
Choosing if and when to perform surgery is a decision that should be made with the help of a vascular anomalies surgeon. It is important to remember that surgery will always leave a scar, no matter when it is performed, so surgery is only chosen if the scar is more favorable than the predicted “scar” left behind by the infantile hemangioma.
Megan M. Gaffey, MD, is a pediatric otolaryngologist at Hassenfeld Children’s Hospital at NYU Langone. She specializes in the medical and surgical treatment of children with complex ENT issues. She has focused training in vascular malformation management.