Infantile Haemangioma

Can be superficial (“strawberry haemangioma” — flat or lumpy, like strawberry jam splashed on the skin) or deep (“cavernous haemangioma” — a bluish swelling). Usually appear shortly after birth; occur in ~10% of infants, 60% on the head and neck.

Natural history

80% of growth occurs in the first 3 months (most stop growing by 5 months, some continue to 18 months). They then involute: 50% resolved by age 5, 70% by 7, 90% by 9 — though regression of bulky lesions is often incomplete, leaving an atrophic “dented” scar or anetoderma.

When to refer

Large, deep or multiple haemangiomas can be associated with organ malformations. Refer:

• prominent facial lesions (cosmetic concern)
• ulcerating haemangiomas
• lesions impairing vision, hearing, breathing or feeding
• lesions in other important locations (e.g. perineum, sacrum).

Management

Active non-treatment is the rule for most lesions. Beta blockers (propranolol, or topical timolol drops/gel) are proven effective for those needing treatment.