Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
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Monroe Carell Jr.
Children's Hospital
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Nashville, TN 37232

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Hemangioma birthmark, vasular anomolyA hemangioma is a type of birthmark. It is a benign (noncancerous) tumor of the skin. They are sometimes called a port wine stain, strawberry hemangioma, or salmon patch. Hemangiomas most often appear on the head or neck. Most will continue to grow for the first 6 to 12 months of life before beginning to shrink.

The most common hemangiomas are bright red raised patches called superficial hemangiomas. Less common, deep hemangiomas appear blue-colored or like a bruise that does not go away.

Do they get better on their own?

Typically, they are not present at birth. After a couple of weeks or months, a small colored spot develops that can look like a red or blue freckle or bug bite, and then it starts to grow over a period of many months. At this point, it stabilizes in size. The hemangioma will then start to diminish in size (called the period of “involution”) over a period of 5 to 7 years.  Sometimes they completely disappear, but larger ones can be replaced with fatty tissue and can leave the skin looking stretched out.

Are all vascular lesions in babies hemangiomas?

No. Hemangiomas are the most common vascular mass in babies, but there are other kinds of problems, typically referred to as “vascular malformations”, that are different than hemangiomas and your doctor will need to determine what kind of vascular lesion your child has to ensure the proper treatment is given.

Do all hemangiomas need treatment?

No. Up until recently, over 90 percent of all children with hemangiomas received no treatment. In many cases, the hemangiomas went away partially or completely.  Babies with hemangiomas affecting their breathing, vision, feeding, hearing or movement typically receive therapy ranging from steroids, laser treatment in the operating room, or surgical to remove the mass.

Propranolol for hemangiomas

Some babies with hemangiomas were given a medicine called propranolol to treat unrelated heart conditions. Parents and doctors were shocked to find the hemangiomas shrinking, with visible results sometimes within days.  Since then, doctors around the world have started to use propranolol in children with normal hearts for hemangioma, and the results are often very good.

Is it dangerous to give a baby propranolol?

Propranolol has been used in infants for over 40 years. The present use for hemangiomas is “off label” in that the FDA has not yet approved the medication for this indication, although testing is ongoing to get it approved in the future. The dose given to the baby is calculated by weight, and is given by a Pediatric Cardiologist here at Vanderbilt, who performs a complete history and physical exam and other testing before prescribing the medicine.  There are some known side effects, such as lowered blood glucose, lowered heart rate, lowered blood pressure, and worsening asthma symptoms, and it is recommended to give the medicine with feeds.  Most of the babies tolerate the medicine extremely well, without side effects noted.

Should my baby start propranolol therapy?

Maybe.  If your child has a hemangioma in a proliferative or stable state that is impacting regular body function or is in a cosmetically sensitive area, it can be very reasonable to consider starting the therapy.

How long does a child need to stay on the propranolol to treat hemangiomas?

Typically, the propranolol is continued for as long as the hemangioma is in its period of proliferation. Once it has disappeared and tapering the medicine does not result in return of the hemangioma, it can be stopped.  It is very common to require a dose adjustment every couple of months before the infant is 1 year old, because the dose is based on weight and the baby grows substantially in the first year.

How effective is propranolol?

Propranolol often works in a setting of hemangioma, but the final result of the medication can be different depending on the individual child. Sometimes there can be residual bulkiness of the area of the hemangioma, and other times there can be some persistent skin changes (for example, telangiectasias, or little vessels, may not completely disappear). Unfortunately, propranolol has not been found effective in treating any other type of vascular lesion.

Are there other therapies for hemangiomas?

Sometimes no treatment is necessary, depending on the site or size of the hemangioma.  Sometimes alternate therapies are offered, such as steroids, laser to the skin or within the hemangioma, or surgical removal.  Every child is different, and customized treatment will be recommended for your child based on many considerations.

Do I need to see a specialist for this problem?

Many infants with hemangioma do not need to see a specialist if the hemangioma is small or not of cosmetic or functional concern.  If there is any impairment of functions, such as vision, breathing, feeding, movement or if there is ulceration and bleeding of the hemangioma, it is recommended the baby be evaluated by a specialist. Doctors seeing your child may include a pediatric dermatologist, pediatric ear, nose and throat surgeon (otolaryngologist), or pediatric plastic surgeon.

Last Edited: December 3, 2014
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