Can Hemangiomas Grow? | Understanding Their Growth

Discovering a new mark on your child’s skin can bring up many questions, especially when it starts to change. Hemangiomas, often called “strawberry marks,” are common benign growths that indeed have a distinct growth pattern. Understanding this natural progression helps parents and caregivers know what to expect and when to seek medical advice.

What Exactly is a Hemangioma?

A hemangioma is a common type of benign vascular tumor, meaning it is a non-cancerous growth made of blood vessels. These growths form due to an abnormal proliferation of endothelial cells, which are the cells lining blood vessels. They are the most common tumors of infancy, affecting approximately 4-5% of infants.

Most hemangiomas are known as infantile hemangiomas (IH), distinguishing them from other vascular anomalies present at birth. They are typically not present at birth but appear within the first few weeks of life, often as a faint red mark or patch. Their characteristic life cycle involves an initial growth phase, followed by a period of natural regression.

The Proliferative Phase: Rapid Growth

The most defining characteristic of an infantile hemangioma is its rapid growth phase, known as the proliferative phase. This period typically begins days or weeks after birth and can continue for several months, often peaking between 3 to 7 months of age. During this time, the hemangioma increases significantly in size, thickness, and color intensity.

Think of this growth like a small seed quickly sprouting and expanding; the blood vessel cells multiply rapidly, causing the lesion to become more prominent. The rate and extent of growth can vary, but it is this initial rapid expansion that often causes concern for parents.

Factors Influencing Proliferation

While the exact cause of hemangiomas is not fully understood, certain factors are associated with an increased likelihood and potentially more pronounced proliferation. These include prematurity, low birth weight, and multiple births, such as twins or triplets. There may also be a genetic predisposition, though most cases are sporadic.

The Involution Phase: Shrinking Back

Following the proliferative phase, hemangiomas naturally enter a period of regression, called the involution phase. This process typically begins around 1 year of age and can continue for several years, often completing by age 5 to 10. During involution, the hemangioma gradually stops growing and starts to shrink.

The color of the hemangioma often changes from a bright red to a duller purple, gray, or skin-colored appearance. The lesion becomes softer and flatter as the blood vessel cells are replaced by fatty and fibrous tissue. While most hemangiomas involute completely, some may leave behind residual skin changes, such as telangiectasias (small dilated blood vessels), atrophy (thinning of the skin), or mild scarring.

Types of Hemangiomas and Their Growth Patterns

Hemangiomas are classified based on their depth within the skin, which influences their appearance and how their growth is perceived.

Superficial Hemangiomas

These are the most commonly recognized type, often called “strawberry marks” due to their bright red, raised, and well-defined appearance. They are located in the uppermost layers of the skin. Their growth is typically outward and upward, making their expansion very noticeable.

Deep Hemangiomas

Deep hemangiomas are located beneath the skin’s surface, making them appear as a bluish or purplish lump. They may not be apparent until they have grown considerably, as the overlying skin can remain normal in color initially. Their growth is deeper, often presenting as a soft tissue mass.

Mixed Hemangiomas

A mixed hemangioma combines both superficial and deep components. These lesions present with a raised, red surface and a deeper, bluish mass underneath. Their growth pattern can be complex, reflecting the expansion of both components.

Segmental hemangiomas are a distinct subtype, often larger and flatter, covering a specific anatomical segment. They carry a higher risk of associated structural anomalies and may require a different monitoring approach.

When Growth Becomes a Concern

While most hemangiomas are benign and resolve without intervention, their growth can sometimes lead to complications requiring medical attention. The location of the hemangioma is a primary determinant of potential issues.

Hemangiomas near vital structures, such as the eyes, nose, mouth, or airway, can interfere with essential functions. Growth around the eye can obstruct vision, potentially leading to amblyopia (lazy eye). Those near the mouth can impair feeding, and lesions in the airway can cause breathing difficulties, which is a medical emergency.

Ulceration, a breakdown of the skin over the hemangioma, is another common complication, especially in areas subject to friction like the diaper area or skin folds. Ulcerated hemangiomas are often painful, prone to infection, and can heal with significant scarring. Very large or rapidly growing hemangiomas, particularly those involving internal organs, can rarely be associated with the Kasabach-Merritt phenomenon, a severe blood clotting disorder.

Monitoring Hemangioma Growth

Regular monitoring by a medical professional is essential for any child with a hemangioma. This allows for accurate assessment of the growth trajectory and early identification of potential complications. Clinical observation involves measuring the size of the hemangioma in three dimensions and noting any changes in color, texture, or associated symptoms.

Photography is a valuable tool for tracking changes over time, providing a visual record of the hemangioma’s progression. Parents play a crucial role in daily observation, noting any new symptoms like pain, bleeding, or changes in the child’s behavior. Open communication with the healthcare provider ensures that any concerns about growth or complications are addressed promptly.

Early intervention is key for problematic hemangiomas, as treatment is generally most effective during the proliferative phase when the hemangioma is actively growing.

Treatment Considerations for Growing Hemangiomas

Not all hemangiomas require treatment; many will involute without intervention and leave minimal residual changes. However, when a hemangioma’s growth poses a risk to function, causes significant disfigurement, or leads to complications, medical treatment becomes necessary. The goal of treatment is to halt growth, accelerate involution, and prevent or manage complications.

Oral propranolol has become the first-line systemic therapy for problematic infantile hemangiomas. This medication, a beta-blocker, works by causing vasoconstriction (narrowing of blood vessels) within the hemangioma, reducing blood flow. It also inhibits the proliferation of endothelial cells and promotes apoptosis (programmed cell death) of these cells, effectively stopping growth and accelerating the shrinking process. Propranolol is highly effective and generally well-tolerated under medical supervision.

Topical beta-blockers, such as timolol gel, are often used for smaller, superficial hemangiomas that do not pose a functional risk. These topical applications can help to reduce the size and redness of the lesion. Laser therapy can be beneficial for treating ulcerated hemangiomas to promote healing or for addressing residual redness and telangiectasias after involution. Surgical excision is typically reserved for hemangiomas that fail to respond to medical therapy, cause significant functional impairment, or leave behind substantial residual skin requiring cosmetic correction after involution.

The choice of treatment depends on the hemangioma’s size, location, depth, the child’s age, and the presence of complications. A multidisciplinary approach involving pediatricians, dermatologists, and other specialists ensures the best care plan for each child.

The Long-Term Outlook

The long-term outlook for most children with hemangiomas is very positive. The vast majority of hemangiomas will involute naturally, with many resolving completely or leaving only minor residual skin changes. Even with residual marks, these are often manageable with cosmetic procedures if desired later in life. For those hemangiomas that required intervention, early and appropriate treatment can significantly improve outcomes, minimizing complications and long-term sequelae.

Ongoing follow-up with a healthcare provider is important to monitor the involution process and address any lingering concerns or complications that may arise. This ensures that children receive comprehensive care throughout the entire course of their hemangioma’s life cycle.