Benign vascular lesions that typically appear during the first weeks of life as blue or pink macules or patches.
Some lesions can be problematic, requiring identification and early treatment and/or referral.
First-line therapy is systemic beta-blockers (such as propranolol).
Infantile hemangiomas, referred to by many simply as "hemangiomas," are benign vascular lesions. Typically they appear during the first weeks of life as blue or pink macules or patches. They subsequently enter a proliferative phase and may become elevated above the surrounding skin surfaces. This growth pattern distinguishes hemangiomas from other vascular lesions. The proliferative growth phase of most hemangiomas is usually completed by the age of 5 months; 80% of growth typically occurs by the end of the third month. Thereafter involution occurs with 90% completion by age 4 years. Complete resolution is possible, but in many cases cutaneous stigmata remain, with redundant fibro-fatty tissue and telangiectasias. Congenital hemangiomas are distinct from infantile hemangiomas. These are vascular lesions that sometimes have a similar clinical appearance to infantile hemangiomas but are fully formed at birth. Specific subtypes of congenital hemangiomas include rapidly involuting congenital hemangiomas and non-involuting congenital hemangiomas. The term "hemangioma" is sometimes used to describe acquired lesions in adults (e.g., cherry hemangioma). These benign lesions rarely undergo involution.
History and exam
Key diagnostic factors
- variable onset
- pink, red, or blue color
- rapid growth
- variable compressibility
- flat or nodular character
Other diagnostic factors
- islands of normal skin
- ulceration and bleeding
- history of low birth weight
- variable pain
- associated defects
- beard distribution and stridor
- lumbosacral location
- multiple lesions
- poor infantile feeding, failure to gain weight
- high-output cardiac failure
- low birth weight
- birth prematurity
- white ethnicity
- female sex
- maternal multiple gestation
- advanced maternal age
- chorionic villus sampling
1st investigations to order
- Doppler ultrasound of hemangioma
Investigations to consider
- MRI of hemangioma
- biopsy of lesion
with functional impairment or cosmetic disfigurement
Kari L. Martin, MD
Associate Professor of Dermatology & Child Health
University of Missouri – Columbia
KLM is an investigator in clinical trials with Scioderm, Lilly, and Durata; payments were received by her institution for these trials. None of these are relevant to this topic.
Dr Kari L. Martin would like to gratefully acknowledge Dr Tobian Muir, Dr Ingrid Polcari, Dr Annette Wagner, and Dr Carla T. Lee, the previous contributors to this topic. TM, IP, and CTL declare that they have no competing interests. AW: none disclosed.
Elena Pope, MD
Department of Dermatology
The Hospital for Sick Children
EP is an author of a number of references cited in this topic.
Elisabeth Higgins, MD
King's College Hospital
EH declares that she has no competing interests.
Iona Friedan, MD
Professor of Clinical Dermatology and Pediatrics
University of California San Francisco
IF is a consultant for Pierre Fabre Dermatology, which is involved in clinical trials of propranolol for hemangiomas. IF is an author of a number of references cited in this topic.
- Venous malformation
- Arteriovenous malformation
- Lymphatic malformation
- Clinical practice guideline for the management of infantile hemangiomas
- Diagnosis and management of infantile hemangioma
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer