7 Common Hemangioma Symptoms You Should Know About

Hemangiomas are benign tumors made up of blood vessels that commonly appear as birthmarks on infants. These vascular growths are among the most common tumors of infancy, affecting approximately 4-5% of babies. While hemangiomas are generally harmless and often resolve on their own over time, understanding their symptoms is crucial for proper monitoring and management. This comprehensive guide explores the key symptoms of hemangiomas, helping parents and caregivers recognize these distinctive marks and understand when medical consultation may be necessary.

Hemangiomas typically appear within the first few weeks of life and go through predictable growth phases. They usually grow rapidly during the first few months, stabilize, and then gradually shrink over several years. Recognizing the characteristic symptoms can help distinguish hemangiomas from other skin conditions and ensure appropriate care.

1. Bright Red or Purple Skin Marks

The most recognizable symptom of a hemangioma is the appearance of a bright red, raised mark on the skin, often described as resembling a strawberry. This distinctive coloration occurs due to the abnormal collection of blood vessels beneath the skin surface.

Characteristics of the discoloration:

• Vivid red or deep purple color, depending on the depth of the hemangioma
• The color may be more intense when the baby cries or strains
• Superficial hemangiomas appear bright red and raised
• Deep hemangiomas may appear blue or purple with a softer texture
• The surrounding skin typically remains normal in appearance

These marks can vary significantly in size, from a few millimeters to several centimeters in diameter. The coloration is usually uniform across the affected area, though some hemangiomas may have varying shades within the same lesion.

2. Raised or Bumpy Skin Surface

Superficial hemangiomas typically present as raised, bumpy lesions that protrude from the skin surface. This elevation is caused by the proliferation of blood vessels creating a mass that pushes upward through the skin layers.

The texture and elevation characteristics include:

• Rubbery or firm consistency when touched
• Uneven, bumpy surface resembling a strawberry or raspberry
• Clear boundaries distinguishing the hemangioma from normal skin
• May feel warm to the touch due to increased blood flow
• The raised area may become more pronounced during the growth phase

The degree of elevation can vary depending on the type and location of the hemangioma. Some may be only slightly raised, while others can protrude significantly from the skin surface, particularly during the proliferative phase.

3. Rapid Growth During Infancy

A hallmark symptom of hemangiomas is their characteristic growth pattern, particularly noticeable during the first few months of life. Parents often report that the mark appears small or barely visible at birth, then grows rapidly during the infant’s first 3-6 months.

Growth pattern indicators:

• Minimal or absent at birth, appearing within the first few weeks of life
• Rapid enlargement during the first 5-7 months
• Growth typically proportionally faster than the baby’s overall growth
• May double or triple in size within weeks
• Growth usually stabilizes around 9-12 months of age

This rapid proliferation phase can be concerning for parents, but it’s a normal characteristic of infantile hemangiomas. Documenting the growth with photographs can help healthcare providers monitor the progression and determine if intervention is necessary.

4. Blanching When Pressure is Applied

When gentle pressure is applied to a hemangioma, the affected area typically blanches or turns pale temporarily. This occurs because the pressure compresses the blood vessels, temporarily reducing blood flow to the area. When pressure is released, the color quickly returns.

This symptom helps differentiate hemangiomas from other conditions:

• The red color fades or disappears completely with firm pressure
• Color returns immediately when pressure is released
• This response confirms the vascular nature of the lesion
• The blanching test can help distinguish hemangiomas from port-wine stains, which typically don’t blanch
• Healthcare providers often use this test during physical examination

While blanching is a common feature, it may be less noticeable in deeper hemangiomas where the blood vessels are located further beneath the skin surface.

5. Location-Specific Complications

Depending on where the hemangioma develops, specific symptoms related to its location may occur. While most hemangiomas cause only cosmetic concerns, those in certain locations can interfere with vital functions.

Location-related symptoms include:

Facial hemangiomas:

• Near the eye: May cause vision problems, drooping eyelid, or blocked tear ducts
• On the nose or lip: Can affect breathing or feeding
• On the ear: May interfere with hearing if blocking the ear canal

Airway hemangiomas:

• Noisy breathing or stridor
• Difficulty breathing, especially when lying down
• Croupy cough
• Feeding difficulties due to breathing problems

Diaper area hemangiomas:

• Increased risk of ulceration and bleeding
• Pain and discomfort during diaper changes
• Potential for infection due to constant moisture and friction

Hemangiomas in these critical locations require close medical monitoring and may need earlier intervention to prevent complications.

6. Ulceration and Bleeding

In some cases, particularly with larger or rapidly growing hemangiomas, the skin surface may break down, leading to ulceration. This is one of the most common complications of hemangiomas, occurring in approximately 5-15% of cases.

Symptoms of ulceration include:

• Open sores or raw areas on the hemangioma surface
• Oozing or weeping from the affected area
• Bleeding that may be difficult to stop
• Crusting or scabbing over the lesion
• Pain and discomfort, especially when touched or during diaper changes
• Increased risk of infection with signs like pus, increased redness, or fever

Ulceration is most common in hemangiomas located in areas subject to friction or moisture, such as the diaper area, neck folds, or lips. Parents should monitor for signs of ulceration and seek medical attention if bleeding persists or signs of infection develop.

7. Gradual Fading and Shrinkage

After the growth phase, hemangiomas enter an involution phase characterized by gradual shrinkage and color fading. This natural resolution is a positive symptom indicating the hemangioma is regressing on its own.

Signs of involution include:

• Color change from bright red to dull red, purple, or gray
• Gradual flattening of the raised surface
• Softening of the previously firm texture
• Appearance of pale or gray areas within the hemangioma
• Reduction in overall size
• This process typically begins around 12-18 months of age
• Complete or near-complete resolution by age 5-10 in most cases

While involution is encouraging, some hemangiomas may leave residual changes such as loose skin, scarring from previous ulceration, or areas of discoloration. The extent of residual changes often depends on the size and location of the original hemangioma.

Main Causes of Hemangioma

While the exact cause of hemangiomas remains not fully understood, researchers have identified several factors that may contribute to their development:

Vascular Development Abnormalities: Hemangiomas result from abnormal proliferation of blood vessel cells during fetal development or shortly after birth. The exact trigger for this excessive growth is still being researched.

Genetic Factors:

• Family history of hemangiomas increases risk
• Certain genetic mutations may predispose infants to developing these vascular tumors
• More common in Caucasian infants

Prematurity and Low Birth Weight:

• Premature babies have significantly higher risk of developing hemangiomas
• Infants with low birth weight are more susceptible
• Risk increases with degree of prematurity

Female Gender: Hemangiomas occur approximately 3-5 times more frequently in girls than boys, suggesting hormonal factors may play a role.

Multiple Births: Twins and other multiples have increased incidence of hemangiomas compared to singleton births.

Placental Abnormalities: Some research suggests that placental tissue abnormalities or cells may contribute to hemangioma formation, though this theory requires further investigation.

Hypoxia: Low oxygen levels in certain tissues may trigger abnormal blood vessel growth as the body attempts to increase blood supply to the affected area.

Prevention Strategies

Unfortunately, there is currently no proven method to prevent hemangiomas from developing, as they result from factors largely beyond parental control. However, understanding risk factors and maintaining optimal prenatal care may help minimize certain risks:

Prenatal Care:

• Maintain regular prenatal checkups to monitor fetal development
• Follow medical advice to reduce risk of premature birth when possible
• Manage any placental complications under medical supervision
• Avoid known teratogens and maintain a healthy pregnancy

Early Detection and Monitoring: While not prevention per se, early identification of hemangiomas allows for:

• Prompt evaluation by healthcare providers
• Regular monitoring of growth patterns
• Early intervention if the hemangioma poses functional risks
• Prevention of complications through appropriate management

Protective Measures for Existing Hemangiomas:

• Protect the area from trauma and injury
• Keep the skin clean and moisturized to prevent ulceration
• Avoid tight clothing that may rub against the hemangioma
• Use gentle handling during bathing and dressing

Parents should focus on regular medical monitoring rather than prevention attempts, as hemangiomas typically cannot be prevented but can be effectively managed when detected early.

Frequently Asked Questions

Are hemangiomas cancerous?

No, hemangiomas are benign (non-cancerous) tumors. They do not spread to other parts of the body and do not turn into cancer. Despite being called tumors, they are simply overgrowths of blood vessels that typically resolve on their own over time.

At what age do hemangiomas stop growing?

Most hemangiomas stop growing between 9 and 12 months of age. The rapid growth phase typically occurs during the first 5-7 months of life, followed by a stabilization period. After this, the hemangioma enters the involution phase where it gradually shrinks over several years.

Do all hemangiomas need treatment?

No, most hemangiomas do not require treatment and resolve on their own without intervention. However, treatment may be recommended if the hemangioma interferes with vision, breathing, or feeding; ulcerates and causes pain; or grows in a cosmetically sensitive area. A healthcare provider can assess whether monitoring or intervention is most appropriate.

Can hemangiomas appear in adults?

Infantile hemangiomas specifically appear in infancy and are rare in adults. However, adults can develop other types of vascular lesions. If a hemangioma from infancy was not completely resolved, some residual mark may persist into adulthood.

How can I tell the difference between a hemangioma and a port-wine stain?

Hemangiomas are typically raised, bright red, and blanch when pressed. They appear after birth and grow rapidly before eventually shrinking. Port-wine stains are flat, dark red to purple, do not blanch with pressure, and are present at birth. Port-wine stains do not resolve spontaneously and tend to darken over time.

Will my baby’s hemangioma leave a scar?

Many hemangiomas resolve completely without scarring, especially smaller ones. However, larger hemangiomas may leave residual changes such as loose skin, minor discoloration, or scarring, particularly if ulceration occurred. The extent of residual changes depends on the size, location, and whether complications developed during the growth phase.

Is it safe to photograph my baby’s hemangioma for monitoring?

Yes, taking regular photographs is actually recommended by healthcare providers to document the growth and progression of the hemangioma. Use consistent lighting and include a measuring reference (like a ruler) to help track size changes over time. These photos can be valuable during medical consultations.

Can my baby have more than one hemangioma?

Yes, some babies develop multiple hemangiomas. When an infant has five or more cutaneous (skin) hemangiomas, healthcare providers may screen for internal hemangiomas, particularly in the liver, as multiple hemangiomas can sometimes be associated with internal involvement.

References:

• Mayo Clinic – Hemangioma
• Cincinnati Children’s Hospital – Hemangioma
• Children’s Hospital of Philadelphia – Hemangiomas
• National Center for Biotechnology Information – Infantile Hemangioma
• Johns Hopkins Medicine – Hemangiomas