Infantile Hemangioma
Treatment

When to Consider Treatment for Infantile Hemangioma

Most infantile hemangiomas do not need treatment, other than monitoring by the child's doctor during routine check-ups. For small hemangiomas in areas covered by clothing, for instance, no treatment is a good option. However, for hemangiomas in certain locations — particularly the face — treatment to prevent further growth or accelerate involution should be considered.

Your child should be evaluated by a vascular anomalies specialist if he or she has a hemangioma in any of the following locations:

  • The face, especially the central face (the eyes, nose or lips) or hemangiomas involving a large portion of the face
  • Tip of the ear
  • Around or behind the eye
  • "Beard area" and center of the neck
  • Over the lower spine
  • In the diaper area, in the armpit or in neck creases

Your child should also be evaluated by a specialist if he or she has:

  • Multiple hemangiomas (there may be a hemangioma in an internal organ as well, which would require treatment)
  • A hemangioma that is growing very rapidly
  • An uncertain diagnosis

Any hemangioma that affects vision, breathing, hearing or eating needs prompt treatment. Even a small hemangioma on the eyelid, for instance, can permanently affect a child's vision.

Treatment Options for Infantile Hemangioma

Hemangiomas are quite variable in terms of their size, location, whether they involve the surface or deeper parts of the skin (or other areas of the body), and in how fast and aggressively they grow. Because of this, treatment is highly individualized.

Management for hemangiomas may include:

Close Observation Without Active Treatment

Small hemangiomas that are likely to resolve without scarring, particularly if they are in areas covered by clothing, often don't need to be treated. However, periodic visits are recommended in early infancy, to be sure there are no problems developing.

Beta-Blocker Medications

Since 2008, beta-blocker medications have become the most commonly used treatment for hemangiomas. Oral propranolol is an FDA-approved medication for treating hemangiomas in infants who are 5 weeks of age or older. The medication is usually given twice a day for at least six months. A topical form of beta-blocker, timolol, is often given as a liquid drop. It is applied directly to the skin for more superficial, less-worrisome hemangiomas that need treatment.

Both of these medications can be extremely effective in stopping hemangioma growth, reducing hemangioma thickness and bulk, and preventing complications.

Laser Therapy

Lasers can be used to treat hemangiomas in a child's airway, to heal ulcerated hemangiomas, to decrease any small blood vessels that remain on the surface of hemangiomas after involution, and to decrease texture changes left on the skin. UCSF's Birthmarks and Vascular Anomalies Center has expertise in laser therapy, including many of the lasers that are used for these indications. Lasers may cause scarring in some cases.

Surgical Removal

Surgical removal is an option for some patients with hemangiomas that have already caused permanent tissue damage, are threatening a vital structure, or are causing recurrent bleeding. It always requires general anesthesia. The scarring that results from surgery must always be weighed against the benefits of removing the hemangioma and compared to other treatment options.

Corticosteroids

Before beta blockers were used, various forms of cortisone were a main treatment for hemangiomas. They can be taken by mouth, or injected into or placed on the surface of the hemangioma. They are used less frequently now, but may be given in some cases if propranolol is not tolerated. They may also be injected in small amounts in specific locations such as the lip or nose. They are most effective when given in the first six months of life.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Birthmarks & Vascular Anomalies Center
1825 Fourth St., Fifth Floor, 5B
San Francisco, CA 94158
Appointments: (415) 353-7823
Fax: (415) 353-7478
Appointment information