Hemangiomas

A hemangioma can be classified, depending upon the depth within the skin, as superficial, deep or mixed. The most common hemangiomas are the superficial and the mixed or combined type which is a combination of both deep and superficial. The three major ways that a hemangioma presents include a pale, white to grey-blue macule (which is the most common), telangiectatic, and the papular forms. Bright-red, papular hemangiomas are known as superficial or "strawberry" hemangiomas. Blue, nodular hemangiomas are referred to as deep hemangiomas.

Hemangiomas arise mainly between 2 and 4 weeks of age, though some are present at birth. Hemangiomas have a 2:1 predilection for female infants over male infants, and manifest frequently in preterm babies as well.

A characteristic feature of the hemangioma is for it to have a rapid growth phase around 4 to 8 week up to 6 to 9 months of age. The growth of the hemangioma is much greater than the growth of the infant. After the rapid growth phase, the hemangioma's growth will slow down and follow the growth of the infant. This is followed by the regression of the hemangioma which begins at some time during the second year of life. The regression phase occurs by initial paling of the hemangioma, followed by flattening. The hemangioma will have reached 50% of maximal regression at year 5 of life and 90% of maximal regression at 9 years of life.

Complications of hemangiomas include ulceration, infection, obstruction of a vital function if located near the trachea, esophagus or eye, or high-output cardiac failure. For example, hemangiomas in the "beard area" can be associated with compromise of the airway. The most common complication is ulceration which can rarely be followed by infection usually with Staphylococcus aureus and sometimes with Pseudomonas aeruginosa as well.