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You may have seen a baby with a "strawberry mark" - a pink or blue colored lesion that can appear anywhere on the body, including the face. These lesions are called hemangiomas [hi-man-jee-oh-muh]. Infantile hemangiomas are the most common type of hemangioma and affect 3-5% of babies. Risk factors for these include being Caucasian and female, and being born prematurely and with low birth weight. Some strawberry marks look like a flat red mark at birth, but can grow rapidly in the first few months of life. The period of most rapid growth seems to fall between 4 and 8 weeks of life based on review of parent photographs. That's a tricky time to catch because the timing of typical well-child checks tends to fall prior to and following that age range.
These tumors will eventually shrink over time, but it takes longer than commonly assumed, sometimes up to a decade. Rapidly growing hemangiomas can lead to complications including ulceration, when the skin breaks down. Ulcerations are painful, can interfere with sleep, and may become infected. Therefore it is important to keep an eye out for skin that looks crusted or dark purple as these can be signs of impending ulceration. Hemangiomas around the diaper area or mouth are particularly susceptible to ulceration.
Strawberry marks growing near the eyes may also interfere with a baby's eye sight. Seeking treatment rather than waiting for the hemangioma to shrink on its own can help prevent any vision problems. Finally, infantile hemangiomas on the face can lead to cosmetic disfigurement when they stretch the skin, and these respond best to early treatment (in the first few months of life).
Because hemangiomas tend to shrink over time, some physicians may choose to watch the lesion before exploring treatment. This is an appropriate strategy as long as the lesion isn't in a cosmetically sensitive location like the face. One concern is that sometimes, the hemangiomas do not totally go away — particularly if they are deep and look blue. Depending on the characteristics of the infantile hemangioma, skin texture may not return to normal even when the strawberry mark regresses, leaving broken blood vessels or sagging skin. Strawberry marks on the face may also cause children to feel self-conscious as they get older.
Fortunately, we have an FDA approved medicine called propranolol for infants with infantile hemangiomas that require treatment. While it was originally developed as a blood pressure medication, the drug was found to be a safe and effective treatment for infants with infantile hemangiomas. The best time to start medication is before the skin is stretched by the hemangioma, or before complications like ulcerations develop. Even so, the medication can still be used in older kids though it isn't as effective. It helps to talk to your pediatrician about a referral to pediatric dermatology if you are concerned about the location or growth pattern of your child's hemangioma.
In some cases, a combination of medication and laser may be the most effective strategy, or surgery, or no treatment at all. Your physician can help you make the best decision for your child, while weighing the risks and benefits involved.