Infantile Haemangioma – Specialist Diagnosis & Monitoring of Baby Birthmarks in London

What is an infantile haemangioma?

An infantile haemangioma is a benign growth of blood vessels that occurs in infants, making it the most common type of vascular birthmark. It develops due to abnormal proliferation of endothelial cells that line blood vessels. These growths are non-cancerous and typically follow a predictable course: rapid growth (proliferative phase), stability (plateau phase), and then gradual shrinking (involution phase). Although most haemangiomas resolve naturally, a significant minority require medical intervention because of their size, location, or complications.

Causes and risk factors

The exact cause of infantile haemangiomas is not fully understood. They are thought to arise from misplaced or overactive endothelial cells during embryonic development. Certain risk factors are well recognised:

• Prematurity: Babies born before term are more likely to develop haemangiomas.
• Low birth weight: Infants under 1.5kg at birth have a significantly higher risk.
• Female sex: Occur up to three times more often in girls.
• Multiple gestation: Twins and triplets are more prone.
• Fair skin: More common in lighter-skinned infants.
• Genetic susceptibility: A family history of vascular anomalies may play a role.

Symptoms and clinical presentation

Haemangiomas may be present at birth as a faint mark or appear within the first few weeks. They usually present as:

• Superficial haemangiomas (“strawberry marks”): Bright red, raised lesions on the skin surface.
• Deep haemangiomas: Blue or skin-coloured swellings deeper in the skin or soft tissues.
• Mixed type: Contain both superficial and deep elements.

During the proliferative phase (0–12 months), they grow rapidly. Some ulcerate, bleed, or become painful. Complications depend on location: around the eyes they may affect vision, near the nose or airway they may obstruct breathing, and in the mouth they can interfere with feeding. Large lesions on the liver or multiple cutaneous lesions may suggest systemic involvement.

Diagnosis and investigations

Diagnosis is primarily clinical, based on the appearance and history of growth. Dermoscopy may help distinguish from other vascular anomalies. Imaging such as ultrasound or MRI is considered if the haemangioma is large, deep, or associated with functional symptoms. If five or more skin haemangiomas are present, abdominal ultrasound may be advised to check for liver involvement. In rare cases, referral to a specialist is needed to evaluate for PHACE syndrome, a condition where haemangiomas are associated with structural abnormalities of the brain, heart, or eyes.

Treatment options

Medical therapy

Propranolol (oral beta-blocker) is the gold standard treatment for problematic infantile haemangiomas. It works by narrowing blood vessels, reducing cell proliferation, and inducing regression. Treatment usually lasts several months, and children require monitoring of blood pressure and heart rate.

Topical timolol may be effective for small, superficial haemangiomas, especially those not requiring systemic therapy.

Corticosteroids were previously first-line but are now reserved for cases where beta-blockers are contraindicated.

Laser and surgical treatment

Pulsed dye laser (PDL) may be used for ulcerated lesions to reduce pain, speed healing, and improve cosmetic outcome. Surgery is rarely required, usually reserved for residual scarring, persistent bulky lesions, or functional obstruction unresponsive to medical therapy.

Supportive care

For ulcerated haemangiomas, wound care, pain management, and infection prevention are crucial. Families often require education and reassurance, as the natural history of most haemangiomas is spontaneous improvement over years.

Complications

• Ulceration: The most common complication, leading to pain, bleeding, and infection.
• Scarring: May persist even after involution.
• Functional impairment: Depending on site, haemangiomas can interfere with sight, breathing, hearing, or feeding.
• Psychological impact: Large or visible haemangiomas can cause parental anxiety and later affect the child’s self-esteem.
• Systemic associations: Multiple haemangiomas may signal internal involvement; large segmental haemangiomas may be linked to PHACE syndrome.

Prognosis and natural history

Most infantile haemangiomas follow a benign course. About 50% resolve by age 5 and up to 90% by age 10. Some leave residual telangiectasia, loose skin, or fibrofatty tissue. Early intervention in complicated cases prevents long-term functional damage and improves cosmetic outcome. With expert monitoring, the outlook for affected children is excellent.

Why choose Skinhorizon for infantile haemangioma care?

• Consultant dermatologist and paediatric dermatology expertise in complex vascular birthmarks.
• Access to gold-standard treatments including propranolol and pulsed dye laser.
• Safe, CQC-regulated environment with full monitoring for infants on therapy.
• Family-centred approach, offering clear explanations and ongoing support.

Your first visit — what to expect

1. History: Birth details, onset of lesion, growth pattern, feeding, breathing, and family history.
2. Examination: Full skin check, lesion measurement, and assessment of complications.
3. Investigations: Ultrasound or MRI if deeper involvement suspected.
4. Treatment planning: Discussion of whether monitoring, propranolol, laser, or wound care is needed.
5. Follow-up: Regular reviews to track growth or regression, adjust therapy, and support parents.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 21 August 2025