Megha M. Tollefson, M.D., Dermatology, Mayo Clinic: Hello. I'm Dr. Megha Tollefson. I'm assistant professor of dermatology and pediatrics at the Mayo Clinic. I'm here today to talk to you a little bit about infantile hemangiomas which are often also called strawberry birthmarks. Infantile hemangiomas are the most common what we call tumor of infancy and tumor not necessarily implying harmful or malignant but implying growth. We estimate that approximately one in twenty children are born with a hemangioma. We're actually conducting a study right now to determine accurately how many children out of a hundred, say, a hundred children are truly born with this birthmark. Our preliminary results are showing that the number of children born with this type of birthmark has actually been increasing steadily over the last thirty years, so it's becoming more and more common. We don't know quite why children get infantile hemangiomas but we do know that there are several fairly well-defined risk factors -- children that are first born, premature, female and have a low birth weight are at a higher risk for developing infantile hemangiomas than other children. However, there are many children that also defy those odds so we certainly see fourth born, male children that are born, you know, at term and normal birth weight that also have these strawberry birthmarks or infantile hemangiomas.
Most infantile hemangiomas will be harmless to the child. They'll grow within the first year of life and then slowly go away little by little. However, there are a subset of infantile hemangiomas that can be quite harmful and and even have complications that it really should be identified quickly and treated by a specialist. Someone who really specializes in taking care of these birthmarks. And some of these higher risk ones are ones that might impede vital functions, such as you know, they're present on the eyelid or they're involving the ear and they're affecting hearing or they're involving the mouth or the lip and they're impacting feeding. Other ones that do require evaluation as soon as possible are large facial hemangiomas which can be the hallmark of associated, other associated conditions such as PHACE syndrome. Multiple hemangiomas can be the hallmark of possible internal involvement with hemangiomas in places like the liver. Other ones can cause bleeding and ulceration. So really any, probably any hemangioma that's large in size, may be impacting a vital function, are present on the head or neck or even the flexural area — such as the groin or the armpit — or any that are causing bleeding or alteration or at risk for significant cosmetic disfigurement should all really be evaluated by someone that specializes in treating infantile hemangiomas.
The question often comes up when is the best time to have someone that has an infantile hemangioma be seen by a specialist and we did recently complete a study along with some colleagues at the University of California in San Francisco that the most rapid time of growth of an infantile hemangioma is actually the first eight weeks of life, and so if we can alter that rate of growth at some point within that eight weeks that probably leaves a child with the best outcome in the long run. So we also looked back to see when would we have ideal you like to see these children that might be at higher risk with their hemangiomas and we found that that's actually about one month of life. So any child where anyone is concerned about the possibility of any complications from their hemangioma ideally should get in with some with someone that specializes in treating hemangiomas within the first month of life.
This is actually a really exciting time for infantile hemangiomas. In the last probably six to seven years, there have been some significant developments in the way that we treat them. We've actually discovered that an old medication that's often used for heart conditions is actually very effective and fairly safe at treating infantile hemangiomas. So there are now new medications both by mouth and topically depending on the location, size, and the potential complications of a hemangioma that that children with hemangiomas can be treated with. While these are you know pretty safe medications and it's also really important to make sure that this is being done under, under the guidance of someone that's used to providing these types of medications and monitoring children that are on these types of medications. There are actually even fairly safe treatment options that can be considered for children whose hemangiomas may not be as large or function-threatening or complicated. Then simply for cosmesis, we may be able to offer offer some fairly safe treatment options. Laser treatment as another treatment that we do sometimes do for infantile hemangiomas. Often it's done in in slightly older kids. This can also be very effective especially in conjunction with some of these other treatments that, that are now available for these kids.
Here at the Mayo Clinic, I am fortunate enough to be able to work with a great team of doctors who are very invested and very experienced in taking care of children that have infantile hemangiomas. Every day I'm able to work with pediatric ear, nose and throat doctors and eye doctors, pediatric plastic surgeons and neurologists and pediatric radiologists who are all able to offer comprehensive multidisciplinary care for children that have infantile hemangiomas.
If you'd like any more information, please visit the Mayo Clinic.org website for information on hemangiomas as well as our infantile hemangioma clinic.