Pediatricians offer new advice about strawberry birthmarks

Submitted by the American Academy of Pediatrics

Seeing a hemangioma develop on their baby's skin can be worrisome for new parents. Hemangiomas are clusters of extra blood vessels on a baby's skin. They may be there when a baby is born or can form within a few weeks or months of birth. Some may look like rubbery, bumpy red "strawberry" patches while others resemble deep bruises. Most are benign - not cancerous - and go away on their own without causing any problems. However, the American Academy of Pediatrics now recommends closely monitoring hemangiomas to ensure they don't cause problems with bodily functions or leave scars.

The AAP says it's important to identify and begin monitoring infantile hemangiomas right after they appear, when they tend to change most quickly.

Some hemangiomas, particularly those on the face or those that are very large, need treatment early to prevent them from interfering with body functions or causing permanent scars. Thankfully, there are excellent treatments available today to help prevent these problems if treated early on.

About infantile hemangiomas

Infantile hemangiomas appear after a baby is born, typically within a month. Roughly 4 to 5 percent of all infants get them, although they are more common in Caucasians, girls, twins, and preterm or low-birth-weight babies. Infantile hemangiomas typically go through a period of rapid growth, followed by more gradual fading and flattening.

There are different types of infantile hemangiomas:

• Superficial hemangiomas have been called "strawberry marks," because they can resemble the surface of berries. They may begin as small white, pink, or red areas on the skin that quickly change into brighter red, raised lesions. Superficial hemangiomas may be focused in one spot or spread out over a larger area.

• Deep hemangiomas have a smooth surface and form under the skin. They may have a bluish tint and resemble bruises. Some cause the skin to look swollen.

• Mixed hemangiomas are a combination of superficial and deep growths.

What to do if you think your baby has an infantile hemangioma:

Infantile hemangiomas usually become noticeable by 4 weeks of age. They may start out looking like a tiny bump or scratch. But many then grow fast when the child is between 5 and 7 weeks old. If you think your baby might have a hemangioma, it's best to contact your baby's pediatrician right away. He or she probably will want to see your baby within a short time frame. According to the AAP, the best "window of opportunity" to be evaluated and start treatment if needed is about 1 month of age.

Your pediatrician will want to know:

• Size: Is the hemangioma small (¾ inch or less across) or larger?

• Location: Is it located on the face or in the diaper area, or a different area?

• Number: Is there one or more than one? If more than one, how many?

The AAP recommends that your pediatrician continue monitoring the hemangioma until it stops growing. Superficial hemangiomas typically reach their full size by 5 months of age, although deep hemangiomas sometimes keep growing a while longer. In some cases, your pediatrician may give a referral to an infantile hemangioma specialist with expertise in pediatric dermatology, hematology-oncology, otolaryngology, or plastic surgery.

By the time a baby is 6 to 18 months old, most hemangiomas begin to improve.

Whether a hemangioma needs treatment depends on the age of the baby, where the hemangioma is located and how fast it is growing, whether it becomes sore or flaky, and the risk of it causing medical complications with a child's health and well-being. Hemangiomas near the child's eyes, nose or mouth, for example, can affect the child's ability to see, eat, breath or hear well. In rare cases, hemangiomas grow inside the body, which may require monitoring with imaging tests. Hemangiomas that cause sores on the child's skin or changes the skin's color or texture may also need treatment.

Treatments available for hemangiomas

If a baby's hemangioma risks causing problems, medications can be applied directly to the skin or taken by mouth. The goal is to keep them from getting any bigger during their period of rapid growth or making them shrink more quickly. Laser procedures or surgery may be an option in some cases, although it generally is avoided during early infancy to prevent increased anesthesia risks.

Contact your pediatrician if you notice anything developing on your baby's skin. Your baby's first few well-child visits are also a great time to bring it up. Few hemangiomas cause any trouble, and most go away on their own. But prompt evaluation, monitoring, and treatment, when needed, can help ensure problem hemangiomas have as little impact as possible on your child.

For more information on child health, visit HealthyChildren.org.

• Children's health is a continuing series. This week's article is from the American Academy of Pediatrics, based in Itasca.