Infantile hemangioma !

Infantile hemangioma is a common benign blood-vessel tumour of babies that grows in the first months and then slowly shrinks.

Updated 2026-11-01

Structures involved

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Why it happens

What it is

The most common benign tumour of infancy: a proliferation of endothelial cells that appears in the first weeks of life, grows rapidly during the first months and then involutes slowly over years. Most need no treatment, but some threaten vision, the airway, feeding or appearance, or are part of a syndrome.

Who gets it

Affects about 4–5% of infants. More common in girls, premature and low-birth-weight babies, multiple pregnancies and infants of fair skin. Most of the growth happens before 3–5 months of age, which is why early referral matters.

Causes

Proliferation of immature endothelial cells, possibly from placental-like or stem-cell progenitors
Tissue hypoxia as a stimulus for vessel growth (VEGF-driven)
Most cases are sporadic, without inherited cause

Risk factors

Prematurity and low birth weight
Female sex
Multiple gestation and placental abnormalities (preeclampsia, placenta previa)
Advanced maternal age

Pathophysiology

Endothelial cells expressing the marker GLUT-1 proliferate rapidly in the first months (proliferative phase). Growth then plateaus and the lesion slowly involutes as vessels are replaced by fibrofatty tissue. Beta-blockers cause vasoconstriction, block growth signals and promote apoptosis of these cells, which is why propranolol works. GLUT-1 positivity separates infantile hemangioma from congenital hemangiomas and vascular malformations.

Classification

By depth: superficial (bright red, 'strawberry'), deep (bluish, soft swelling) and mixed
By pattern: focal, segmental (plaque covering a developmental area, higher risk of complications and syndromes), indeterminate and multifocal
Associated syndromes: PHACE (large segmental facial hemangioma with posterior fossa, arterial, cardiac and eye anomalies) and LUMBAR (lumbosacral hemangioma with spinal and urogenital anomalies)

Symptoms and signs

A faint mark or pale patch at birth that becomes a bright red, raised, lobulated lesion in weeks
Deep lesions: soft, warm, bluish swelling
Rapid growth in the first 3–5 months, then stabilisation
Slow fading to grey and flattening during involution, sometimes leaving residual skin changes
Most common on the head and neck

Diagnosis

Clinical: Clinical diagnosis based on timing (absent or subtle at birth, rapid early growth) and appearance; serial photographs document growth.
Tests: Usually none. GLUT-1 immunostaining on biopsy if diagnosis is unclear. Thyroid function in large liver hemangiomas. Before propranolol: history and examination focused on heart rate, blood pressure, breathing and blood glucose risk.
Imaging: Ultrasound with Doppler for deep or uncertain lesions; abdominal ultrasound with five or more skin lesions; MRI/MRA of the brain and neck, echocardiography and eye examination for suspected PHACE; spinal ultrasound or MRI for lumbosacral lesions; airway endoscopy if stridor.

Differential diagnosis

Congenital hemangiomas (fully formed at birth, GLUT-1 negative)
Capillary malformation (port-wine stain, present at birth and grows with the child)
Venous and lymphatic malformations
Pyogenic granuloma
Kaposiform hemangioendothelioma and tufted angioma (associated with platelet trapping)

Goal of treatment

Identify high-risk hemangiomas early, ideally before 1–3 months of age, treat them during the growth phase to prevent complications and disfigurement, and simply observe low-risk lesions.

Treatment

Follow-up: Active observation with photographs for small, low-risk lesions, which involute on their own.
Medical: Oral propranolol (a non-selective beta-blocker) is first-line for high-risk hemangiomas, started in the proliferative phase under paediatric supervision; topical timolol for small, thin superficial lesions.
Acute: Ulcer care with barrier dressings, pain control and treatment of secondary infection; urgent airway or eye management for obstructing lesions.
Procedure: Pulsed-dye laser for ulceration or residual redness, and surgical or laser correction of residual fibrofatty tissue after involution.

Complications

Ulceration, bleeding and infection
Amblyopia, astigmatism and strabismus from periocular lesions
Airway obstruction from subglottic hemangioma
Permanent disfigurement or residual fibrofatty tissue
High-output heart failure and consumptive hypothyroidism with large liver hemangiomas
Propranolol adverse effects: hypoglycaemia, bradycardia, hypotension, bronchospasm, sleep disturbance

Prognosis

Most involute spontaneously over several years, but up to half leave residual changes (telangiectasia, loose skin, fibrofatty tissue). Treated high-risk lesions respond well to propranolol, with occasional regrowth after stopping.

Test yourself

Think of the answer, then tap the question to see it.

What is the natural history of an infantile hemangioma?

Absent or subtle at birth, rapid growth in the first months (proliferation), then slow involution over years.

What is the first-line treatment for a high-risk infantile hemangioma?

Oral propranolol, a non-selective beta-blocker.

Which immunohistochemical marker is positive in infantile hemangioma?

GLUT-1.

A 'beard' distribution hemangioma raises concern for what?

A subglottic airway hemangioma; watch for stridor.

Which adverse effect of propranolol is especially important for nurses to teach parents to prevent?

Hypoglycaemia: give the drug with feeds and hold it if the infant is not eating or is vomiting.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Hemangioma (MedlinePlus, US National Library of Medicine, 2026); Infantile haemangioma: Complications and treatment (DermNet, 2026).

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Representative model, for educational purposes only.

Skin highlighted on the Durgical 3D model