Infantile hemangioma are benign neoplasms that occur in about 5-10% of newborns, making them the most common vascular tumours. These benign tumours of blood vessels can elicit so many questions and misconceptions in parents and those who have the responsibility of taking care of children.
Prof. Dr. Ikram Ullah Khan, the best dermatologist in Islamabad, uses some of the most advanced technologies to remove birth marks or hemangiomas. Despite the uncertainty of the factors that may cause these birthmarks, researchers are working on discovering more about hemangioma growth. To clarify this issue, Prof. Dr. Ikram Ullah Khan dispel seven myths about infantile hemangiomas that may be common among the population.
What is Strawberry Hemangioma?
A strawberry hemangioma is an aggregation of several small blood vessels in the skin. There is a congenital hemangioma that forms a raised red skin growth which might be present at birth or develop during infancy. A hemangioma is red and resembles a strawberry stain but is in fact a kind of tumour which is actually benign. It is also possible to encounter its synonym – vascular birthmark.
In some cases the tumor appears to grow for the first year and decreases in the subsequent years without any intervention. It is reported that 10% may be lost before the child is a year old. Of the rest, 90% of hemangiomas eventually regress by age 10 years.
Hemangiomas are particularly common in children and babies. They are not generally noticed at birth and usually appear in the first few days or months of life of an infant or child on affected side. They may develop at any area of the skin but are frequently found in the head or face region. When they first arise they are a fairly fast-growing presence. They are commonly known to pop out later and later on reduce in size before they finally fade away.
Myth 1: Hemangiomas are Very Dangerous and a Form of Cancer
Fact: These tumors are called infantile hemangiomas and they are not cancerous at all. It forms when a cluster of blood vessels develop in the wrong manner. Although they may seem to be a problem, they do not result in severe health complications In most of the time. The majority of hemangomas spontaneously regress at some time regardless of any intervention. However, when they affect vital functions or lead to complications, medical intervention might be necessary.
Myth 2: They Are Present at Birth
Fact: Some birthmarks might be present at birth but IH usually becomes noticeable in the first few weeks of the baby’s life. At first, they may be very small and inconspicuous: they often express themselves most vigorously between the first 6-12 months of life and then steadily decline for the next several months.
Myth 3: Hemangiomas Only Occur in Infants
Fact: While the majority of the infantile hemangiomas do appear during the infancy, they may also occur in the later childhood. However, there is a need to distinguish them from other forms of vascular anomalies closely related to hemangiomas but that differ in morphology.
Myth 4: Hemangiomas Should Be Treated As Soon As Possible
Fact: Some hemangiomas do not require intervention at all. MANY of them will automatically decrease and even vanish without any external interference. Treatment is typically given only in cases where hemangiomas are problematic, which may include those located anywhere near the eyes or mouth, in case there might be problems with vision or eating, or if the hemangiomas are so ulcerated or bleeding.
Myth 5: Hemangiomas Are Known to Worsen with Sun Exposure
Fact: As for the argument that sun exposure may exacerbate hemangiomas, it lacks scientific foundation. Nevertheless, it is always very important to avoid sun exposure especially in children with hemangioma and even in those without. Application of sunscreen and protective clothing should be recommended for all children.
Myth 6: You Can Prevent Hemangiomas
Fact: Currently, there are no known ways of preventing the development of IHs. They are not as a result of something which parents do or fail to do during pregnancy or after the child is born. They are only a consequence of new blood vessels formation.
Myth 7: Hemangiomas are Caused by Mother’s Pregnancy Stress or Trauma
Fact: This belief is unfounded. Hemangiomas are congenital, which means their etiology cannot be accurately described. Contrary to some of the potential causes that have been suggested earlier like stress, trauma or other dangers to the pregnant mother, there is no known scientific explanation of the specific causes of the hemangiomas.
When to Call the Doctor
If the area looks infected, you should call your child’s doctor or health care provider immediately. Signs of infection include:
- Pus, redness, pain
- Skin opens or oozes
- Skin dies and it turns into an open wound or ulcer.
Fever:
- Newborn up to 1 month – Above 100.4 F/ 38 C
- More than 3 months – over 104°F (40°C).
- Above the average temperature of 102°F (38.9°C) for more than two days or have recurring symptoms.
Also call if you have concerns about a hemangioma medicine, like:
- You fail to complete a recommended course of a drug.
- Your child does not want to take any medicine in the oral administration.
You are concerned about possible side effects like:
- Drowsiness
- Fussiness
- Wheezing or noisy breathing
- Not eating well
- Fever and sick while on oral medicine
Hemangioma Treatment
If your child’s hemangioma has to be treated, your child’s doctor or health care provider will discuss this with you. The treatment mostly differs depending on the size, location and whether or not it is troublesome to your child. Treatments may include:
- Topical beta blockers may reduce the hue and size of the hemangioma. This procedure is most effective on flat or narrow based hemangiomas, which are not deep in the skin.
- Topical antibiotics are used for treating open skin wounds due to possibility of bacterial infection.
- Oral medicine (taken by mouth) – The child is likely to be monitored for side effects. Some of them may require them to undergo a checkup before they begin these medicines. Propranolol is the first line oral therapy. Enlargement of the hemangioma may be treated with prednisone if propranolol is not helpful or unavailable for use in your child.
- Surgery – This may involve excision where your child undergoes surgery to have this condition removed. This is rare. It might be carried out when the hemangioma has ceased to grow or other forms of treatment have been ineffective. Your child may also require a surgical procedure to remove the marks or remnants with hemangiomas.
- Laser – This may lighten the look of blood vessels left over from hemangiomas.
Pulsed Dye Lasers for Treatment
Pulsed dye laser (PDL) with dynamic cooling device is now the cornerstone in the treatment of the superficial blotchy red color of the hemangioma. It can also be used to slow the spread; to decrease the inflammation and prepare for other treatments. It is normal to undergo many sessions in order to accomplish the desired objective.
In accordance to the case type of the lesion, the age of the child and the site of the hemangioma, the treatments can be performed with or without the use of anesthesia. The method is always the least traumatic and safest for each patient. The PDL can be helpful in the healing of those hemangiomas that get ulcerated or break open into the skin. This is especially useful for the lesions in the diaper area.
Management of Deep and Airway Hemangiomas
The Nd:YAG laser is applied to eliminate the subdermal component of hemangiomas involving the oral cavity, larynx (voice box) and less often the skin. Such a laser must be effectively employed by experienced dermatologists only. Therefore, visit the yop skin specialist in Islamabad, Prof. Dr. Ikram Ullah Khan.
Lasers CO2, Erbium lasers, which are more deep resurfacing lasers, helps in scar revisions and enhancement of the skin’s texture after involution. In children, these have to be used very carefully also, and one has to be very cautious about it.
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