Conditions - Hemangiomas

Hemangiomas are strawberry-colored "birthmarks". They are not rare, and vary from tiny blebs to large and multiple tumor-like growths. They are not true birthmarks since they are mostly not seen at birth, but start in infancy and then begin to grow. Hemangiomas first appear from birth up to 18 months, and then slowly shrink. Port wine stains and other true birthmarks are fully formed at birth and do not grow wider.

Hemangiomas that require early aggressive treatment include those that are cosmetically deforming, growing rapidly or obstructing vision, hearing, breathing, eating or any other body function. Hemangiomas on the lower face and neck may later block internal airways. Large facial hemangiomas may cause psychosocial impairment. Also, larger hemangiomas that are left alone to regress (shrink away over years) will eventually look better if the resulting saggy, stretched out skin and fatty tissue is surgically removed.

Most hemangiomas when first diagnosed are superficial only. These can be treated with a laser as soon as they are diagnosed, and early treatment is key as laser becomes less effective if you wait. The laser selects the red and shrinks the vessels so that the result is a less noticeable lesion. Repeated treatments can almost completely remove the superficial component. However, since the laser can only penetrate 1-3mm, it cannot shrink any deep component. Sometimes early treatment will prevent further growth, although deeper portions may still persist and grow. The flash-lamp pulse dye, pump dye and sclero-laser are the primary lasers used for treating hemangiomas. The risk of scarring is small. Complete removal of every trace should not be expected.
 

Symptoms

Strawberry hemangiomas are bright red (or purple), soft, raised, squishy birthmarks with sharp borders. They often start as little red dots surrounded by a pale halo before they grow. They are most common on the head, chest, or upper back.

Deeper cavernous hemangiomas often appear bluish, and the borders look less distinct. If the hemangioma is deep enough, the overlying skin might look normal. Most are found on the head or neck.

Most hemangiomas grow rapidly, doubling their size, and then plateau for a while before collapsing and disappearing. When the color becomes dull, or the center appears gray or pinkish-gray, the hemangioma may be entering the slow disappearing phase.

Treatment

Cavernous hemangiomas that involve the eyelid and obstruct vision are generally treated with injections of steroids or laser treatments that rapidly reduce the size of the lesions, allowing normal vision to develop. Large cavernous hemangiomas or mixed hemangiomas are treated, when appropriate, with oral steroids and injections of steroids directly into the hemangioma.

Recently, lasers have been used to reduce the bulk of the hemangiomas. Lasers emitting yellow light selectively damage the vessels in the hemangioma without damaging the overlying skin. Some physicians are using a combination of steroid injection and laser therapy together.