and Treating Hemangiomas in Children: A Parent's Guide

Hemangioma

Hello Dr.
Chen,
My daughter is over 3 years old, and recently I noticed a red spot on the upper left side of her chest.
It seems to be gradually getting larger, and it is neither itchy nor painful (though she doesn't like anyone touching it, and sometimes when I press it and ask if it hurts, she says it does).
I would like to ask what this phenomenon could be and why the red spot is forming.
How should it be treated? If it breaks, will it bleed excessively? Thank you!

wawa, 20~29 year old female. Ask Date: 2004/01/08

Dr. Chen Rongtai reply Pediatrics

Vascular abnormalities can be either a singular defect or part of a syndrome, and they can generally be categorized into two main types: hemangiomas and vascular malformations.
Hemangiomas typically appear within a few weeks after birth, initially growing larger and then gradually regressing over time.
In contrast, vascular malformations are usually present at birth and do not regress as they enlarge over time.
The inquiry mentioned hemangiomas but did not include any images.
It is indeed very difficult to draw a conclusion without a detailed examination and assessment.
It is advisable to take the child to an outpatient clinic for a thorough evaluation before discussing any concerns.

Reply Date: 2004/01/08

More Info

Hemangiomas are benign tumors made up of blood vessels that commonly appear in infants and young children. They often present as red or purple marks on the skin and can vary in size. In your case, your daughter has developed a red spot on her chest that is gradually increasing in size. This is a typical presentation of a hemangioma, which is often referred to as a "strawberry mark" due to its appearance.

Understanding Hemangiomas
1. Nature of Hemangiomas: Hemangiomas are generally non-cancerous and are the most common type of vascular tumor in children. They usually appear shortly after birth or within the first few weeks of life. The exact cause of hemangiomas is not fully understood, but they are believed to result from an abnormal proliferation of blood vessels.

2. Growth Patterns: Hemangiomas typically go through a growth phase, where they can enlarge rapidly, followed by a period of involution, where they gradually shrink and fade over time. Most hemangiomas will resolve on their own by the time a child reaches school age, although some may take longer.

3. Symptoms and Concerns: In many cases, hemangiomas are asymptomatic, meaning they do not cause pain or discomfort. However, if the hemangioma is located in a sensitive area or grows large enough to cause functional issues, it may require treatment. Your daughter’s hemangioma, which is not itchy or painful, is likely benign, but it’s understandable to be concerned about its growth.

Treatment Options
1. Observation: For many hemangiomas, especially those that are not causing any symptoms or complications, the best course of action is simply to monitor them. Regular check-ups with a pediatrician or dermatologist can help track the hemangioma's growth and involution.

2. Medical Treatment: If a hemangioma is large, growing rapidly, or causing complications (such as ulceration or interference with vision or breathing), treatment options may include:
- Oral Propranolol: This medication has been shown to be effective in reducing the size of hemangiomas and is often the first-line treatment for problematic cases.

- Topical Treatments: In some cases, topical beta-blockers may be used for superficial hemangiomas.

- Laser Therapy: This can be effective for hemangiomas that have ulcerated or for those that are causing cosmetic concerns.

3. Surgical Intervention: Surgery is generally reserved for cases where the hemangioma is causing significant functional impairment or if it does not respond to other treatments. This is less common, as most hemangiomas resolve without intervention.

Risks of Rupture
If a hemangioma were to rupture, it could potentially bleed, but significant blood loss is rare. Hemangiomas are vascular lesions, and while they can bleed, they typically do not cause severe hemorrhaging. If your daughter’s hemangioma appears to be at risk of rupture (for example, if it becomes ulcerated), it is essential to consult a healthcare provider for appropriate management.

When to Seek Medical Advice
- If the hemangioma changes in appearance, becomes painful, or shows signs of ulceration.

- If you have concerns about its growth or if it starts to interfere with normal activities.

- If you notice any unusual symptoms such as bleeding or infection.

Conclusion
In summary, your daughter’s red spot is likely a hemangioma, which is usually benign and self-limiting. Regular monitoring is often sufficient, but if you have concerns or if the hemangioma changes, it’s best to consult with a pediatric dermatologist or a healthcare provider specializing in vascular anomalies. They can provide guidance tailored to your daughter’s specific situation and help you understand the best course of action.

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