Facts about these Birthmarks (Hemangiomas) Linda G. Rabinowitz, MD, FAAP, FAAD Hemangiomas are common benign vascular tumors (growths) occurring in up to 10% of infants during the first year of life. They are characterized by growing and subsequent disappearing phases leading to spontaneous regression in most cases. These lesions occur three times more often in girls than in boys. The reason for this remains unclear. Sometimes these lesions occur in families. Hemangiomas are either superficial (strawberry), deep (cavernous), or both (mixed). Superficial hemangiomas are the most common of the three types. Although the exact cause of hemangiomas is poorly understood, the natural course of these lesions is well-documented. Often they are absent at birth, but appear within the first few weeks of life. The initial lesion may be a flat red or white spot, which usually has visible tiny blood vessels in the center. During the first six months of life, the lesion grows at a very rapid rate. Parents are often alarmed at how fast these lesions can grow. After six months of age, the growth continues, but at a slower rate, and this peaks at about 10 to 12 months. Involution (the process of disappearing) often begins at about one year of age, but this natural resolution process may take years. It is difficult to predict how long a particular hemangioma will take to resolve. By five years of age, approximately 50% of hemangiomas are gone; 90% have resolved by nine years of age. During involution, the hemangioma changes from a bright cherry red color to a dull purple color with white or gray areas of fibrosis. Growth may continue slowly in some areas even after regression has begun in other areas of the hemangioma. The color eventually fades and the size of the birthmark decreases. The remaining skin may be wrinkled and pale. Scarring is inevitable in hemangiomas which have ulcerated (broken down) during their course. Treatment can include, but is not limited to, observation (wait and see), compression (mask), corticosteroids (prednisone), freezing (cryotherapy), surgical excision, interferon, and pulsed dye laser therapy. Doctors who are very familiar with hemangiomas can explain which of these treatments is best for your child. Hemangiomas can create stressful situations especially when the parents and child are out in the public eye. Acquiring as much information as possible will help everyone cope better with these birthmarks that seem to last forever. Just remember, over 95% of hemangiomas resolve. The waiting period is the hardest part, but there are many of us who are interested in helping families deal with the problems related to this common birthmark. I hope you enjoy Gianna's special story as much as I did. Gianna's Wild Strawberry ©1998 Dana Roberson Guerra.  Illustrated by Molly Troxell.  Website by Michael Höhne

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