Hemangiomas and pyogenic granulomas are types of vascular birthmarks known as vascular tumors. The diagnosis of a hemangioma or pyogenic granuloma is often a big surprise, but there are several reasons why parents can take heart.
What Is a Hemangioma?
A hemangioma is an over-growth of the cells that make up the lining of blood vessels, called endothelial cells. If it occurs in the superficial layers of skin, it is usually bright red and elevated (hence the lay term of “strawberry birthmark”). If it occurs below the skin, then it appears bluish. 1 in 20 children are diagnosed with a hemangioma, and most hemangiomas are not present at birth but rather develop within a few weeks after birth. The natural history consists of 9 months of rapid proliferation followed by slow shrinkage over the next 3.5 years. By this time, roughly 50% of hemangiomas are no longer visible.
The vast majority of hemangiomas disappear by elementary school age on their own. Accordingly, we simply observe about 90% of our hemangioma patients because the hemangiomas are small, do not involve visibly sensitive areas of the body, and will most likely disappear. For large hemangiomas and ones in sensitive areas (such as the face, hands/feet, and genitalia), a combination of medical, laser, and surgical options can limit the size of the hemangioma, speed up its disappearance, and limit long-term scarring or deformity.
Should I Be Concerned about a Hemangioma?
The vast majority of hemangiomas disappear by elementary school age; however, a minority of hemangiomas can be troublesome prior to their disappearance. And sometimes issues can arise despite their disappearance.
Bleeding or an Open Wound
Some hemangiomas can grow so fast that they develop bleeding. A small area of bleeding can be managed with a topical anti-bleeding agent and good wound care. Larger areas may require a pulse of a laser to seal the vessels and/or the initiation of medical therapy.
Obstruction of Vision, Hearing, Breathing, or Swallowing
Other indications for early evaluation and treatment include lesions that obstruct vital functions such as vision, hearing, or feeding. These are managed more aggressively, and require prompt initiation of medical therapy or even excision.
Destruction of Surrounding Skin or Cartilage
Even though a hemangioma resolves, the effects of the hemangiomas may remain. For example, the skin may have been stretched significantly and appear thin and irregular, or the hemangioma might have deformed nose or ear cartilage and leave a deformity. A fatty deposit can also remain after the hemangiomas itself has resolved. In these instances, several options exist for maximizing function and appearance, and may include laser therapy or surgical treatments.
Why Is an Early Evaluation Important?
Our governing philosophy is to monitor hemangiomas closely, and to intervene when necessary to optimize appearance by the time your child reaches the 1st grade. For large hemangiomas and ones in sensitive areas (such as the face, hands/feet, and genitalia), several options exist for treatment.
Limit the Size of the Hemangioma
The first year of life corresponds to a rapid growth phase of a hemangioma (a rate that far out-paces the growth of your child). Two different medications can limit (and in some cases decrease) the size of the hemangioma.
Accelerate the Resolution of a Hemangioma
Roughly 60% of hemangiomas are expected to disappear by kindergarten. Some resolve earlier and some resolve later. Specific laser therapies can accelerate the resolution process.
Decrease the Chances of Residual Scar or Deformity
Although the vast majority of hemangiomas resolve on their own, 30% of them leave a scar or deformity to the skin or surrounding anatomy. Laser therapy and surgical techniques can limit the visibility of a residual deformity.
What is a Pyogenic Granuloma?
A pyogenic granuloma is a type of vascular tumor. It is a rapidly growing skin lesion that is prone to bleeding. Unlike most hemangiomas, pyogenic granulomas do not disappear on their own. However, only about 10% require treatment.
If you have questions about your child’s hemangioma, we can help. Call us at 512-600-2888.