Infantile Hemangioma - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Infantile hemangioma is a typical vascular benign lesion. It is one of childhood's most common benign head and neck lesions. It is a benign tumor that consists of vascular endothelium. A growth phase and an involution phase characterize it. It usually gets bigger after three weeks and fades away on its own. It is self-limiting in nature; however, it can cause complications such as ulceration and cosmetic disfigurement. It usually appears as a reddish-blue colored lesion with a raised nodular appearance. It is also known as a strawberry nevus.

What Is Infantile Hemangioma?

Infantile hemangiomas are benign vascular malformations characterized by proliferation and spontaneous involution. It is made up of blood vessels that increase and proliferate. Infantile hemangioma is seen as a colored patch or mark on the skin surface within a few weeks after birth. Infantile hemangioma proliferates after the first five months of birth. It is in maximum size approximately during the first three months of age. It stops growing and begins to shrink in size on the child's first birthday. The condition is more commonly seen in girl children. It may leave some scars on tissues on skin surfaces.

What Are the Phases of Infantile Hemangioma?

Following are the phases of growth of infantile hemangioma.

• Proliferative Phase - In this phase, the lesion proliferates a few weeks after the child's birth. The proliferative phase of infantile hemangioma can continue for several months. The onset of the lesion is sudden, and the progression is rapid.

• Involution Phase - In this phase, the growth of the infantile hemangioma starts to inflate. Then, the lesion begins to shrink. This process takes time. Usually, hemangioma is completely involved when the child turns five. After involution, the skin looks normal. However, in some cases, there is the presence of scarring.

What Are the Types of Infantile Hemangioma?

Following are the various types of hemangioma seen in Infants.

• Congenital Hemangioma - Hemangiomas visible at birth are known as congenital hemangiomas. They increase during the first few weeks of delivery.

• Superficial Hemangioma - It is also known as cutaneous hemangioma and the skin surface hemangioma. It is a bright, bumpy red in appearance. It is also known as strawberry hemangioma.

• Deep Hemangioma - It grows under the deeper surface of the skin. It appears as a nodular bulge with a bluish-purple tint. It is also known as under-the-skin and subcutaneous hemangioma.

• Mixed Hemangioma - If the hemangioma is present on the more profound and superficial parts of the skin, it is known as mixed infantile hemangioma.

What Are the Causes of Infantile Hemangioma?

The rapid proliferation of blood vessels and vascular endothelium causes infantile hemangioma. The multiplication of the vascular endothelium is more than that of normal cells. The blood vessels receive signals to proliferate in the early weeks after the child's birth. Various angiogenesis factors, such as vascular endothelial growth factors, also act as triggering factors for angiogenesis.

What Are the Risks for Babies With Hemangiomas of the Skin?

Following are the various risk factors for babies with hemangiomas of the skin.

• Preterm birth of the child.

• Placental abnormalities.

• Bleeding disorder and complications during pregnancy.

• Use of progesterone.

• Female child.

What Are the Clinical Features of Infantile Hemangioma?

A hemangioma can be superficial, involving only a superficial layer; deep type, involving several layers; and mixed type. Superficial hemangioma is bright red and appears as an elevated nodule on the skin surface. Deep hemangioma is bluish-red and appears patchy on the skin's surface. The temperature of the lesion is raised if the child has a deep hemangioma.

The lesion is well-circumscribed and remains focal. The lesion size ranges from 0.20 inches to 1.97, inches during the first few weeks after birth; however, it increases rapidly to approximately 20 centimeters. The hemangioma can have an elevated, dome-shaped lobulated, plaque-like, and tumor-like appearance. The hemangioma progresses in the following stages.

• Presence of blanching in involved skin.

• There is a presence of shallow ulceration, mostly with lips and buttock lesions.

• Presence of fine telangiectasis.

• A halo of vascular blanching surrounds the presence of a bright red macule or papule.

How Infantile Hemangioma Is Diagnosed?

Following are the various diagnostic steps that are used to diagnose infantile hemangioma.

• Diascopy Test - This is done to investigate the presence or absence of blanching in the lesion. Mild pressure is applied to the lesion with the help of a glass slide. Color changes and blanching are observed. The presence of blanching indicated the lesion is of vascular origin.

• Laboratory Investigations - Laboratory investigation of serum and urinary vascular endothelial growth factor, urinary beta fibroblast growth factor, and urinary matrix metalloprotease is indicated.

• Magnetic Resonance Imaging (MRI) - Magnetic resonance imaging helps to diagnose the location and extent of hemangioma. It helps in the differentiation of proliferative hemangioma from arteriovenous malformation.

• Ultrasonography - It helps differentiate hemangioma from other deep dermal and subcutaneous structures and evaluates the extent of the hemangioma.

• Biopsy - A skin biopsy is performed if the diagnosis is questionable. Infantile hemangioma stains positively for the glucose transporter one gene. It degrades positively during both the proliferative and involution phases.

What Are the Treatment Plans for Infantile Hemangioma?

The treatment plan for hemangioma depends upon the lesion's size, shape, location, type, and extension. Treatment is not required for small invasive lesions as they involute by themselves. However, hemangioma, which causes complications such as skin ulceration, bleeding problems, feeding difficulties, vision, and growth impairment, requires treatment.

Following is the treatment plan for infantile hemangioma.

• Beta-blockers such as oral Propanol are indicated for the lesions.

• Steroid medication is given to the child.

• Injection of the sclerosing agent is indicated.

• Embolization of blood vessels is done.

• Laser or surgical removal of the lesion is done.

What Are the Complications of Infantile Hemangioma?

The complications of infantile hemangiomas are as follows:

• Ulceration on the skin surface.

• If the hemangioma is present in certain areas, such as the nose, eyes, and mouth, it may interfere with normal functioning and can cause breathing difficulties, vision impairment, and feeding difficulties.

• Cosmetic concerns.

• If present in the throat, it can cause airway obstruction.

• Psychological challenges, such as stress.

• Functional impairment of internal organs.

Conclusion:

Infantile hemangioma is a common birthmark in children, found in the infants' skin, chest, head, and neck. It varies among infants. Hemangioma grows and changes with a period. It is categorized under hamartoma. The metastatic spread is absent in hemangioma. However, there can be present proliferation, followed by the gradual shrinking of the lesion. It can also cause cosmetic concerns in children. Treatment should be started as early as possible. The treatment includes medications, such as beta-blockers and steroids. In some cases, surgical removal is recommended.