The Camacho Family: Hemangioma/Vascular Birthmarks.

HEMANGIOMAS: WHAT ARE THEY?

Hemangiomas are simply a collection of extra blood vessels in the skin. They may have different appearances depending on the depth of the increased numbers of blood vessels.

Hemangioma Specialists Hemangioma Specialists
Fig. A

Strawberry Hemangioma is an abnormal collection of blood vessels in the skin characterized by a bright red color and well-defined border.

A Deep or Cavernous Hemangioma is a large, collection of blood vessels beneath the skin surface characterized by a soft, bluish, or skin colored mass.

A Combined Hemangioma is a combination of a deep and superficial (strawberry) hemangioma.

Hemangioma
Hemangioma in one-year-old baby

HEMANGIOMAS: HOW COMMON ARE THEY?

Hemangiomas are one of the most common birthmarks in newborns. Most hemangiomas are not present at birth but develop within the first few weeks to months of life. They are found in up to 10 percent of babies by the age of one.

HEMANGIOMAS: WHY DO THEY OCCUR?

The cause of hemangiomas is unknown. In very rare instances they may run in families, but in general they are not inherited. For a parent with a child with this birthmark, there is no increased risk of having a subsequent child with a hemangioma. Hemangiomas are more common in girl babies than boys. They are also more commonly seen in premature infants.

TYPICAL GROWTH PATTERN OF HEMANGIOMAS: WHEN WILL THEY GO AWAY?

Age of Child Hemangiomas
Birth often not present or noticeable
1-2 months becomes noticeable
1-6 months grows most rapidly
12-18 months begins to shrink (involute)

Hemangiomas usually involute (shrink away) in time. 30% of hemangiomas will resolve by 3 years of age 50% by 5 years of age, and 80%-90% by 9 years of age. Over one-half of hemangiomas heal with an excellent cosmetic result without treatment.

WHICH HEMANGIOMAS NEED TREATMENT?

Hemangiomas usually appear, grow and go away without problems. In most cases, we do not recommend treatment. Some hemangiomas can cause significant problems, however. Scenarios that may be more complicated and require treatment include:

1) Involvement of a vital organ, like the eye or ear, or windpipe
2) Bleeding
3) Ulceration
4) Crusting or infection
5) Rapid growth and deformity of the surrounding tissues

Hemangiomas in certain areas may have a higher risk of complications. These areas include the face (especially nose and lips), body folds, and groin. Hemangiomas in certain locations, which affect function, or are complicated by infection or ulceration, may be treated with laser, medication, or injections. If any worrisome signs appear such as these listed above, please contact your physician.
Hemangioma Treatment Hemangioma Treatment
Hemangioma Under the Eye Before Pulsed Dye Laser Treatment and Cortisone Hemangioma Under the Eye After Pulsed Dye Laser Treatment and Cortisone
Hemangioma Treatment Hemangioma Treatment
Fig. Baby born with hemangioma on scalp before treatment. Notice the open sores which have developed within the birthmark leading to pain and discomfort for the baby. Fig. Same baby after multiple laser treatments and injections of cortisone into the birthmark.

WHAT TREATMENTS ARE AVAILABLE?

In many instances no treatment will be indicated. If treatment is needed, however, it may include:

Cortisone: Injected into the hemangioma or given orally by mouth. If given orally for prolonged periods has side effects including increased risk of systemic infection, high blood pressure, diabetes, increased appetite, stomach irritation, growth suppression, etc.

Pulsed Dye Laser Therapy: This therapy treats the superficial blood vessels best. If this treatment is recommended it is usually reserved for the superficial component of hemangioma, characterized by a flat, red lesion. It is usually administered in a series of laser treatments spaced 2-4 weeks apart.

Antibiotics: If the hemangioma is infected and open it may be treated with a short course of antibiotics and daily wound cleansing.

Alpha Interferon: This therapy is limited to the most severe and potentially life threatening hemangiomas. It involves administering systemic medication via daily shots, usually into the leg, for several months. It is usually given to the baby by the parents under physician direction and supervision. This therapy has serious potential side effects including neurologic effects, blood abnormalities and others.

Surgical removal: In rare instances, hemangiomas may be surgically removed especially if they are not likely to resolve spontaneously or lead to significant tissue distortion and deformation.
HEMANGIOMAS: WHAT ARE THEY?

Hemangiomas are simply a collection of extra blood vessels in the skin. They may have different appearances depending on the depth of the increased numbers of blood vessels.
Strawberry Hemangioma is an abnormal collection of blood vessels in the skin characterized by a bright red color and well-defined border.
A Deep or Cavernous Hemangioma is a large, collection of blood vessels beneath the skin surface characterized by a soft, bluish, or skin colored mass.
A Combined Hemangioma is a combination of a deep and superficial (strawberry) hemangioma.

HEMANGIOMAS: HOW COMMON ARE THEY?

Hemangiomas are one of the most common birthmarks in newborns. Most hemangiomas are not present at birth but develop within the first few weeks to months of life. They are found in up to 10 percent of babies by the age of one.

HEMANGIOMAS: WHY DO THEY OCCUR?

The cause of hemangiomas is unknown. In very rare instances they may run in families, but in general they are not inherited. For a parent with a child with this birthmark, there is no increased risk of having a subsequent child with a hemangioma. Hemangiomas are more common in girl babies than boys. They are also more commonly seen in premature infants.

TYPICAL GROWTH PATTERN OF HEMANGIOMAS: WHEN WILL THEY GO AWAY?

Age of Child Hemangiomas
Birth often not present or noticeable
1-2 months becomes noticeable
1-6 months grows most rapidly
12-18 months begins to shrink (involute)

Hemangiomas usually involute (shrink away) in time. 30% of hemangiomas will resolve by 3 years of age 50% by 5 years of age, and 80%-90% by 9 years of age. Over one-half of hemangiomas heal with an excellent cosmetic result without treatment.

WHICH HEMANGIOMAS NEED TREATMENT?

Hemangiomas usually appear, grow and go away without problems. In most cases, we do not recommend treatment. Some hemangiomas can cause significant problems, however. Scenarios that may be more complicated and require treatment include:

1) Involvement of a vital organ, like the eye or ear, or windpipe
2) Bleeding
3) Ulceration
4) Crusting or infection
5) Rapid growth and deformity of the surrounding tissues

Hemangiomas in certain areas may have a higher risk of complications. These areas include the face (especially nose and lips), body folds, and groin. Hemangiomas in certain locations, which affect function, or are complicated by infection or ulceration, may be treated with laser, medication, or injections. If any worrisome signs appear such as these listed above, please contact your physician.
Hemangioma Treatment Hemangioma Treatment
Hemangioma Under the Eye Before Pulsed Dye Laser Treatment and Cortisone Hemangioma Under the Eye After Pulsed Dye Laser Treatment and Cortisone
Hemangioma Treatment Hemangioma Treatment
Fig. Baby born with hemangioma on scalp before treatment. Notice the open sores which have developed within the birthmark leading to pain and discomfort for the baby. Fig. Same baby after multiple laser treatments and injections of cortisone into the birthmark.

WHAT TREATMENTS ARE AVAILABLE?

In many instances no treatment will be indicated. If treatment is needed, however, it may include:

Cortisone: Injected into the hemangioma or given orally by mouth. If given orally for prolonged periods has side effects including increased risk of systemic infection, high blood pressure, diabetes, increased appetite, stomach irritation, growth suppression, etc.

Pulsed Dye Laser Therapy: This therapy treats the superficial blood vessels best. If this treatment is recommended it is usually reserved for the superficial component of hemangioma, characterized by a flat, red lesion. It is usually administered in a series of laser treatments spaced 2-4 weeks apart.

Antibiotics: If the hemangioma is infected and open it may be treated with a short course of antibiotics and daily wound cleansing.

Alpha Interferon: This therapy is limited to the most severe and potentially life threatening hemangiomas. It involves administering systemic medication via daily shots, usually into the leg, for several months. It is usually given to the baby by the parents under physician direction and supervision. This therapy has serious potential side effects including neurologic effects, blood abnormalities and others.

Surgical removal: In rare instances, hemangiomas may be surgically removed especially if they are not likely to resolve spontaneously or lead to significant tissue distortion and deformation.

So Ashleigh has had a combined hemangioma since when was 1 month old. It was small at first and we thought that she has a bruise from a bulb syringe when she had a cold. We quickly learned that what we thought was a bruise was not but a hemangioma. It was growing rapidly to when she was 2 1/2 months she was unable to breath. We saw a ENT at Primary's Children Medical Center but at the time all he wanted to do was take pictures and have us come back as we waited to see what is would do, he never had any treatment plan from him on any of the visits but just pictures being taken. These appointments eventually led us to a dermetologist at Primary's who knew right away what we were dealing with and how to treat it. She put Ashleigh on steriods to get it to stop growing. She was on it for 7 months and it did make it stop growing, it did not go away, and she gained alot of weight from water due to the steroids. Every year we had a follow up visit with a dr. for it. We saw another ENT right after we had Joshua, and he said that it would be best to sugically remove it but it would be better to wait til she was older because she could handle it better and it would not scar as bad. He suggested when she was ready to start Kindergarten. So in April of this year we started looking into removing it this summer. We eventually were led to a plastic surgeon who led us back to the first ENT who I didn't like. But I did give him the benefit of the doubt. He ordered a MRI to look inside it to determine what it was doing at this point. We learned that the blood was gone but was replaced with fatty tissue. The fatty tissue would grow with her and then cause problems later in life. He agreed with the help of the plastic surgeon to remove it. The surgery was done last Thursday at Primary's. It was a 2 hour surgery with a 2 hour recovery and considered outpatient. She did really well during the surgery and she never threw up after they woke her up. I was nervous how things would turn out so I did not sleep well the night before. When we got home, she wanted to eat lots of different things since we had to fast the night before. She was suppose to eat soft solids but we wee told to give her what she asked for and that was what we did. She had a hard time settling down when we got home, and we ended up taking a walk to our mailbox but she quickly got tired and dizzy so that ended fast. She wanted to go to her first day of Kindergarten, but the DR. said no, so we kept her home. She has not complained too much about her nose hurting unless it was bothering her but it hasn't been often, and she is excited that her "bump" is gone. He face is swollen and bruise and she may have to have touch up surgery anywhere from 2 to 10 years. I am glad to it is gone and that she will no longer have to live with it. But I was always able to see past it and see a beautiful little girl that she is. Her is a few pictures i have taken over the years and from the night before and through the weekend.