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Yale New Haven Children’s Hospital’s pediatric interventional radiology team is recognized as pioneers in the field of minimally invasive medicine. In addition to physicians, the team includes advanced practice providers, nurses, and radiology technologists who support our ability to provide image-guided, non-surgical treatments for vascular and non-vascular disease with excellent outcomes for pediatric patients.
Some infants develop a type of birthmark, either at birth or soon after, called an infantile hemangioma. This is a growth formed by collections of extra blood vessels in the skin and is among the most common vascular birthmarks. About 4 - 5% of infants have an infantile hemangioma, and some babies are born with more than one. Their specific cause is unknown, but tend to be more common in girls, premature babies, and in twins and triplets.
Hemangiomas appear as bright red bumps, patches or bluish lumps anywhere on the surface of the skin. These growths can grow quickly but go away very slowly. Typically, hemangiomas first appear in babies from the ages of 2 weeks to 2 months, growing rapidly for the first month or so, then continuing to grow until about 5 or 6 months of age.
About 80 percent of hemangiomas stop growing by 5 months. Often, they stay unchanged for several months, and then begin to slowly disappear over time. By the time children reach about 5 years of age, most hemangiomas have resolved.
Hemangiomas can be harmless, but in some cases, the growths will ulcerate (form sores), which can be extremely painful for babies. These ulcers can appear anywhere, but high-risk sites include the lips, neck, diaper area, lower back and folds such as the armpit. Ulcers associated with hemangiomas always leave scars.
Even if they do not ulcerate, hemangiomas can leave a permanent mark left behind after they shrink. The high-risk areas for permanent skin changes are the lip, nose, ear, cheek, forehead or eyelid.
Hemangiomas near the eye may compromise an infant’s vision either by closing the eyelid completely or by putting pressure on the eye and blurring vision. If a baby has a hemangioma on or near the eye, an evaluation by a pediatric ophthalmologist and a pediatric dermatologist is recommended.
Large hemangiomas on the face, head and/or neck are also concerning. Although rare, infants with large hemangiomas in these locations may have additional birth defects.
If a baby has a large hemangioma on their lower back, it could be a sign of associated spinal cord abnormalities. Even if the hemangioma looks like it’s not causing the baby any problems, if it is present in any of these areas, it should be evaluated by a pediatric dermatologist.
There are no known links between the condition and maternal diet, genetics, environmental factors or parental behavior. The cause of these birthmarks is unknown.
Hemangiomas have a distinctive appearance, pattern of growth and coloration. Hemangiomas near the surface of the skin evolve from small red patches to bright red bumps. Hemangiomas lacking the bright red color and/or with a purple or blue hue may originate deeper below the skin. The hemangiomas in deeper tissues require further evaluation through ultrasound with Doppler or magnetic resonance imaging (MRI).
Imaging technology can detect increased blood flow in a hemangioma, helping in early detection, diagnosis and treatment in some cases.
If a baby has multiple hemangiomas on the skin’s surface and is younger than 6 months of age, the doctors may perform an ultrasound of the liver to make sure that the baby doesn’t have liver (or other internal) hemangiomas. While internal hemangiomas are rare, they most commonly appear on the liver.
Most hemangiomas will disappear on their own over time. But, for more medically or cosmetically concerning ones, pediatric dermatologists treat them mostly with a group of drugs called beta blockers, to prevent disfigurement, scarring, or a medical complication such as impaired vision.
Another treatment option is pulsed dye laser surgery. It is used for superficial hemangiomas, to speed up the healing of ulcerating hemangiomas and for the remaining red vessels that are left behind after the hemangioma resolves. The pulsed dye laser works well to remove any residual red discoloration from the skin. Once hemangiomas disappear, they can leave a scar or saggy skin.
We offer treatments in both office settings and hospital, including laser treatments and surgeries performed under general anesthesia at our Pediatric Specialty Center. The physicians take the time to explain every part of the process to parents. After treatment, our pediatric specialty team continues to work with the child’s pediatrician and dermatologist to ensure a seamless coordination of care.
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