II. Epidemiology

  1. Prevalence: 1.1 - 2.6% of all newborns (10% of infants at one year)
  2. More common in Premature Infants

III. Signs

  1. Often lesion not present at birth or barely noticeable pale patch of skin
  2. Distribution
    1. Midline
    2. Beard region
  3. Erythematous or violaceous lobulated lesions

IV. Differential Diagnosis

  1. Thrombocytopenia
  2. Cardiac failure
  3. Cutaneous Signs of Spinal Dysraphism (e.g. sacral Hemangioma)

V. Associated Conditions

  1. Kasabach-Merritt Syndrome
  2. Tethered Cord with lumbosacral lesions
    1. See Cutaneous Signs of Spinal Dysraphism

VI. Course

  1. Develops in first four weeks after birth
  2. Proliferates until 9 to 12 months of age
  3. Spontaneous Resolution
    1. Age 5 years: 50% resolution
    2. Age 7 years: 70% resolution
    3. Age 9 years: 90% resolution
  4. Residual atrophy, Hypopigmentation, Telangiectases, or scarring may occur

VII. Management: First-Line

  1. Propranolol
    1. FDA approved for age 5 weeks and older
    2. Well tolerated and very effective at facilitating Hemangioma involution when used in the first year of life
    3. Start in first months of life to prevent proliferation and continue for 6 months
    4. Dose: 1 mg/kg orally twice daily
      1. Give dose after feeding to prevent Hypoglycemia
      2. May be increased up to 2-3 mg/kg twice daily if needed
    5. References
      1. Léauté-Labrèze (2015) N Engl J Med 372(8):735-46 +PMID: 25693013 [PubMed]

VIII. Management: Refractory (Interventions by Pediatric Dermatology)

  1. Compression garment or Coban Tape
    1. Hemangiomas on arms or legs
  2. Biosynthetic dressing every 24 hours
  3. Prednisone
    1. Indicated where Hemangioma compresses eye, airway or other vital conditions
    2. Dose: 3 mg/kg daily for 6-12 weeks
    3. Continue until lesion stops growing or size decreases
  4. Interferon alfa (if refractory to Steroids)
  5. Sirolimus
  6. Topical Timolol Maleate
  7. Pulsed-dye laser therapy

IX. Management: Indications for referral or further evaluation

  1. Multiple Hemangiomas
    1. Consider Ultrasound of the Abdomen to evaluate for gastrointestinal and Liver Lesions
  2. Deep Hemangiomas
  3. Large Hemangiomas
    1. Risk of high-output Heart Failure
  4. Sacral Hemangiomas
    1. See Cutaneous Signs of Spinal Dysraphism
  5. Airway Hemangioma
    1. May present with Stridor
    2. Airway Hemangiomas tend to enlarge through the first year of life
  6. Eyelid Hemangioma
    1. May block Vision

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Related Studies

Ontology: Hemangioma (C0018916)

Definition (CHV) A benign skin lesion consisting of dense, usually elevated masses of dilated blood vessels
Definition (CHV) A benign skin lesion consisting of dense, usually elevated masses of dilated blood vessels
Definition (CHV) A benign skin lesion consisting of dense, usually elevated masses of dilated blood vessels
Definition (CHV) benign tumors that are made up of small blood vessels.
Definition (CHV) benign tumors that are made up of small blood vessels.
Definition (CHV) a benign tumor of the blood vessels that appears on skin
Definition (CHV) a benign tumor of the blood vessels that appears on skin
Definition (CHV) a benign tumor of the blood vessels that appears on skin
Definition (CHV) a benign tumor of the blood vessels that appears on skin
Definition (NCI) A benign vascular neoplasm characterized by the formation of capillary-sized or cavernous vascular channels.
Definition (NCI_CDISC) A benign vascular neoplasm characterized by the formation of capillary-sized or cavernous vascular channels.
Definition (CSP) extremely common benign tumor, occurring most commonly in infancy and childhood, made up of newly formed blood vessels, and resulting from malformation of angioblastic tissue of fetal life; can occur anywhere in the body but is most frequently noticed in the skin and subcutaneous tissues.
Definition (MSH) A vascular anomaly due to proliferation of BLOOD VESSELS that forms a tumor-like mass. The common types involve CAPILLARIES and VEINS. It can occur anywhere in the body but is most frequently noticed in the SKIN and SUBCUTANEOUS TISSUE. (from Stedman, 27th ed, 2000)
Concepts Neoplastic Process (T191)
MSH D006391
ICD9 228.00, 228.0
ICD10 D18.0 , M9120/0, D18.00
SnomedCT 2099007, 154625006, 189194008, 189199003, 93474003, 189863005, 269646001, 367337005, 189192007, 189193002, 254822005, 400210000, 253053003
English Hemangioma, Hemangioma, any site, Angioma - benign, Haemangioma unspecified site, Haemangioma, any site, [M]Haemangioma NOS, [M]Hemangioma NOS, hemangioma (physical finding), hemangioma (diagnosis), hemangioma, Hemangioma, no ICD-O subtype, Hemangioma unspecified site, Angioma NOS, Hemangioma [Disease/Finding], Haemangioma, unspecified site, Hemangioma, unspecified site, haemangiomas, angiomas, hemangiomas, benign hemangioma, angioma, benign hemangiomas, Hemangiomas, Hemangioma of unspecified site (disorder), [M]Hemangioma NOS (morphologic abnormality), Hemangioma NOS (disorder), Angioma - benign (disorder), Haemangioma (disorder), Haemangioma, site unspecified, Hemangioma, no ICD-O subtype (morphologic abnormality), Hemangioma, no International Classification of Diseases for Oncology subtype, Hemangioma, no International Classification of Diseases for Oncology subtype (morphologic abnormality), Hemangioma, site unspecified, ANGIOMA, HEMANGIOMA, BENIGN, BENIGN ANGIOMA, BENIGN HEMANGIOMA, Angioma, Benign haemangioma, Benign hemangioma, Haemangioma, Haemangioma - morphology, Hemangioma - morphology, Hemangioma (disorder), Benign hemangioma (morphologic abnormality), Angioma, NOS, Hemangioma, NOS, Haemangioma, NOS, Hemangioma (morphologic abnormality), Hemangioma of unspecified site, Haemangioma NOS, Haemangioma of unspecified site, Hemangioma NOS, Angioma (benign), Benign Angioma, Benign Hemangioma, haemangioma
French ANGIOME, Angiome, Hémangiome SAI, Hémangiome, tout site, Hémangiome de site non précisé, Angiome (bénin), Hémangiome, site non précisé, Hémangiome à site non précisé, Hémangiome
Portuguese ANGIOMA, Hemangioma de qualquer localização, Angioma, Hemangioma de local NE, Hemangioma NE, Angioma benigno, Hemangioma de localização NE, Hemangioma
Spanish ANGIOMA, Hemangioma, cualquier localización, Hemangioma de localización no especificada, Angioma, Hemangioma NEOM, Angioma (benigno), Hemangioma ensitio no especificado, hemangioma, no clasificado como subtipo en CIE-O (anomalía morfológica), hemangioma, sin subtipo en CIE O, hemangioma, no clasificado como subtipo en CIE-O, hemangioma, sin subtipo en CIE O (anomalía morfológica), angioma benigno, hemangioma, SAI (trastorno), hemangioma de localización no especificada, hemangioma de localización no especificada (trastorno), [M]hemangioma, SAI (anomalía morfológica), [M]hemangioma, SAI, angioma benigno (trastorno), hemangioma, SAI, angioma, hemangioma (anomalía morfológica), hemangioma (trastorno), hemangioma benigno (anomalía morfológica), hemangioma benigno, hemangioma de localización no especificada (concepto no activo), hemangioma, morfología, hemangioma, sin localización específica, hemangioma, Hemangioma
Dutch hemangioom NAO, hemangioom, elke plaats, hemangioom van niet-gespecificeerde plaats, hemangioom op elke plaats, angioom (benigne), hemangioom op een niet-gespecificeerde plaats, angioom, Hemangioom, elke lokalisatie, hemangioom, Angioom, Hemangioom
German Haemangiom an unspezifischer Stelle, Haemangiom NNB, Angiom, Haemangiom, beliebige Stelle, Angiom (gutartig), ANGIOM, Haemangiom, jede Lokalisation, Haemangiom, Hämangiom
Italian Emangioma NAS, Angioma, Emangioma, ogni sede, Emangioma di sede non specificata, Angioma (benigno), Emangioma
Japanese 部位不明の血管腫, 血管腫(良性), 血管腫、部位を問わない, 血管腫NOS, ケッカンシュNOS, ケッカンシュ, ブイフメイノケッカンシュ, ケッカンシュリョウセイ, ケッカンシュブイヲトワナイ, 血管腫-筋肉内, 血管腫-絨毛, 血管腫-組織細胞様, 組織細胞様血管腫, 絨毛血管腫, 血管腫, 筋肉内血管腫
Swedish Hemangiom
Czech hemangiom, Hemangiom, jakékoli místo, Angiom (benigní), Hemangiom NOS, Hemangiom blíže neurčeného místa, Hemangiom, Angiom
Finnish Hemangiooma
Korean 모든 부위의 혈관종
Polish Naczyniak krwionośny, Naczyniak
Hungarian Haemangioma k.m.n., Jóindulatú érdaganat, bármely helyen, Jóindulatú érdaganat, Angioma (jóindulatú), Jóindulatú érdaganat k.m.n., Nem meghatározott elhelyezkedésű haemangioma, Nem meghatározott elhelyezkedésű érdaganat, Angioma, Haemangioma
Norwegian Hemangiom, Blodkarsvulst, Blodkartumor

Ontology: Strawberry nevus of skin (C0206733)

Definition (NCI) A capillary hemangioma that may regress spontaneously. It occurs in infants and children.
Definition (MSH) A dull red, firm, dome-shaped hemangioma, sharply demarcated from surrounding skin, usually located on the head and neck, which grows rapidly and generally undergoes regression and involution without scarring. It is caused by proliferation of immature capillary vessels in active stroma, and is usually present at birth or occurs within the first two or three months of life. (Dorland, 27th ed)
Concepts Neoplastic Process (T191)
MSH D018324
ICD10 M9131/0 , Q82.5
SnomedCT 205560007, 402867006, 83343001, 56975005, 254206003
English Hemangioma, Capillary, Capillary Hemangiomas, Hemangiomas, Capillary, Capillary Hemangioma, STRAWBERRY MARK, Infantile Hemangioendothelioma, Strawberry Nevus, Juvenile Capillary Hemangioma, strawberry nevus (diagnosis), strawberry nevus (physical finding), capillary hemangioma (physical finding), strawberry nevus, capillary hemangioma, hemangioma capillary, strawberry nevus was observed, Cellular Hemangioma, Hemangioma, Capillary [Disease/Finding], capillary hemangiomas, angiomas strawberry, hemangiomas infantile, hemangiomas strawberry, strawberry birthmark, capillary haemangioma, mark strawberry, strawberry hemangioma, strawberry naevus, hemangioma strawberry, juvenile hemangioma, Mark;raspberry, Mark;strawberry, hemangioma simplex, infantile hemangioma, nevus capillary, birthmarks strawberry, marks strawberry, plexiform hemangioma, strawberry angioma, Infantile Hemangioma, Juvenile Hemangioma, Capillary hemangioma, Hemangioma simplex, Infantile hemangioma, Plexiform hemangioma, Juvenile hemangioma, Strawberry mark, Raspberry mark of skin, Strawberry hemangioma of skin, Strawberry mark of skin, Angiomatous naevus, Angiomatous naevus of skin, Angiomatous nevus, Angiomatous nevus of skin, Capillary haemangioma, Capillary haemangioma of skin, Capillary hemangioma of skin, Capillary naevus, Capillary naevus of skin, Capillary nevus, Capillary nevus of skin, Congenital vascular naevus, Congenital vascular nevus, Haemangioma simplex, Infantile haemangioma, Juvenile haemangioma, Plexiform haemangioma, Strawberry angioma, Strawberry naevus, Strawberry nevus, Strawberry haemangioma of skin, Strawberry birthmark, Capillary hemangioma (disorder), Capillary hemangioma (morphologic abnormality), Congenital vascular hamartoma, Congenital vascular nevus (disorder), Strawberry naevus of skin, Strawberry nevus of skin (disorder), Strawberry nevus of skin, capillary; hemangioma, capillary; nevus, hemangioma; capillary, hemangioma; infantile, hemangioma; juvenile, hemangioma; plexiform, hemangioma; simplex, infantile; hemangioma, juvenile; hemangioma, nevus; angiomatous, nevus; capillary, nevus; strawberry, plexiform; hemangioma, simplex; hemangioma, strawberry; nevus, angiomatous; nevus, Strawberry nevus of skin, NOS, raspberry mark, strawberry mark
Spanish nevo en fresa de la piel, nevo angiomatoso cutáneo (trastorno), nevo frutilla, nevo angiomatoso cutáneo, Hemangioma simple, Nevus capilar, Marca de color fresa, Nevus en fresa, nevo en fresa de la piel (trastorno), nevo frutilla (trastorno), NEVUS EN FRESA, Nevus de color fresa, hemangioma capilar (anomalía morfológica), hemangioma capilar (trastorno), hemangioma capilar, hemangioma en fresa de la piel, hemangioma infantil, hemangioma juvenil, hemangioma plexiforme, hemangioma simple, marca en fresa de la piel, nevo angiomatoso, nevo capilar, nevus vascular congénito (trastorno), nevus vascular congénito, nevo vascular congénito (trastorno), nevo vascular congénito, Hemangioma Capilar
Dutch aardbeinaevus, haemangioma simplex, aardbeivlek, hemangioom simplex, capillaire naevus, aardbei; naevus, angiomateus; naevus, capillair; hemangioom, capillair; naevus, hemangioom; capillair, hemangioom; infantiel, hemangioom; juveniel, hemangioom; plexiform, hemangioom; simplex, infantiel; hemangioom, juveniel; hemangioom, naevus; aardbei, naevus; angiomateus, naevus; capillair, plexiform; hemangioom, simplex; hemangioom, Capillair hemangioom, Hemangioom, capillair
French Naevus capillaire, Angiome plan, Angiome simple, Névus fraise, Naevus fraise, Hémangiome simplex, ANGIOME TUBEREUX, Hémangiome capillaire
German Erdbeermal, Haemangioma simplex, kapillaerer Naevus, Erdbeernaevus, Kapillarnaevus, FEUERMAL, Hämangiom, kapilläres
Italian Nevo capillare, Nevo a fragola, Macchia di fragola, Emangioma simplex, Emangioma capillare
Portuguese Nevo morango, Nevo cor de morango, Hemangioma simples, Nevo capilar, Sinal morango, ANGIOMA VIOLACEO, Hemangioma Capilar
Japanese いちご状母斑, 単純血管腫, 毛細血管性母斑, タンジュンケッカンシュ, モウサイケッカンセイボハン, イチゴジョウボハン, イチゴジョウケッカンシュ, いちご状血管腫
Swedish Hemangiom, kapillärt
Czech hemangiom kapilární, Prostý hemangiom, Kapilární hemangion, Kapilární hemangiom, Kapilární névus, Jednoduchý hemangiom
Finnish Kapillaarinen hemangiooma
Polish Naczyniak krwionośny włośniczkowaty
Hungarian Eper nevus, Capillaris naevus, Haemangioma simplex, Eper naevus, Dermalis haemangioma, Jóindulatú egyszerű érdaganat
Norwegian Kapillært hemangiom