Director of Paediatrics and Paediatric Surgery, Max Institute of Paediatrics, Max Healthcare Institute, New Delhi
What are haemangiomas?
Haemangiomas are noncancerous, abnormally dense collections of dilated small blood vessels that may occur in the skin or internal organs. They may be present at the time of birth or may develop shortly after. They mostly resolve on their own by 5 to10 years of age but some may take several years to disappear. Haemangiomas on the face may be disfiguring and may interfere with vision.
How are they caused?
The cause of haemangiomas is not known. They may be present as a common birthmark. Haemangiomas are usually painless. They are visible red skin lesions that may be present on the top layer of the skin, deep in the skin or somewhere in between.
They may be present at birth or may appear a few months later. They undergo a rapid growth phase in which their volume and size increases rapidly. This is followed by a rest phase, in which they change very little and an involutional or degeneration phase when they undergo spontaneous regression and may disappear completely.
What are the various types of Haemangiomas?
Stork bite haemangiomas: It appears as a birthmark in babies. It is deep pink in colour and is commonly found on the eyelids, forehead and nape of the neck. It may be quite visible initially but fades away within a few months.
Strawberry haemangioma: It appears as a bright red, raised, compressible birthmark not visible at birth. It enlarges rapidly afterwards, grows till a few months and then begins to shrink slowly. Grey flecks of tissue cover the bright red surface of the mark. Blood is squeezed out of the vessels and they disappear. Eventually only a flat, light patch of skin remains.
Cavernous haemangioma: It appears as a wild, jumbled growth of blood vessels. It is present at birth but starts to enlarge rapidly afterwards. It may attain a large size and may cause disfigurement or blockage of the vital organs. It grows for some time, stabilizes and then gradually disappears.
Port wine stain: It is a rather darker birthmark, deep red to purple in colour. It is often present on the face and does not fade away on its own.
How are they diagnosed?
Haemangiomas are diagnosed by physical examination. In the case of deep lesions, a CT scan or MRI scan may be performed to assess the effect of involvement of the deeper structures.
What is the treatment?
Superficial haemangiomas do not require treatment initially as they regress on their own, leaving the skin normal. Cavernous haemangiomas that involve the eyelid and obstruct vision are generally treated with steroid injections or laser rays. The injection may be directed into the haemangioma and lasers emitting yellow light may be used to damage the vessels in the hemangioma without damaging the overlying skin. More recently, interferon has been used to treat large haemangiomas that encroach on vital structures.
What are the complications involved?
The blood vessels in the haemangioma may cause the formation of platelet clots. These clots can consume platelets so rapidly that there may be a reduction in the level of platelets in the blood. This may lead to severe bleeding elsewhere in the body.
Large haemangiomas may develop secondary infections, ulcerate and bleed. They may become so large in size that they may interfere with normal vision, breathing, feeding and with other vital functions.