FFinalistSouthampton · 2027
Dermatology
AKT · Dermatology/Benign lesions

Infantile haemangioma

Benign proliferation of vascular endothelium

Overview

The commonest benign tumour of infancy — a proliferation of vascular endothelium ("strawberry naevus"). Typically appears in the first weeks of life, proliferates for months, then spontaneously involutes over years. Most need only reassurance; a minority need treatment for complications.

Recognise

  • Appears in the first few weeks (often not present at birth), a bright-red, raised, lobulated "strawberry" plaque
  • Natural history: proliferation (first months) → plateau → slow involution over several years (often gone by school age)
  • Deep haemangiomas look bluish; superficial ones are bright red

Red flags

  • Periocular (amblyopia/vision), airway ("beard" distribution → stridor), nasal-tip/lip, large facial (PHACE syndrome), multiple/hepatic, or ulcerating haemangiomas need urgent treatment

Differentials & how to tell them apart

Capillary malformation (port-wine stain)present at birth, flat, does NOT involute, grows with the child (Sturge-Weber if trigeminal V1)
Pyogenic granulomaacquired, rapidly growing, bleeds readily, not the infantile proliferation-involution course
Naevus simplex ("stork bite")flat pink patch on the nape/eyelids, fades

Clinical image

We can't host this one — the image is DermNet's and their licence doesn't cover us republishing it. Their page for it is free to view.

Infantile haemangioma — clinical imagesDermNet

Investigations

Clinical. Imaging for large/multiple/segmental (PHACE), airway or hepatic involvement.

Management

Reassurance and observation (most involute); oral propranolol if complicated

  1. 1Reassure and observe uncomplicated lesions — they involute spontaneously over years.Gate: Treat (oral propranolol) rather than wait if the haemangioma threatens function or is high-risk — periocular (vision), airway/"beard" (stridor), nasal-tip/lip, large facial (PHACE), ulcerating, or multiple/hepatic
  2. 2First-line treatment = oral propranolol (with cardiovascular screening/monitoring); topical timolol for small superficial lesions; ulceration → wound care.
Observation / reassurance — most uncomplicated haemangiomas — they involute
Oral propranolol — first-line for problematic/complicated haemangiomas (accelerates involution)
Topical timolol — small superficial lesions

Key points

The proliferation-then-involution course distinguishes it from a port-wine stain (present at birth, permanent). Propranolol transformed management of complicated haemangiomas.

Monitor & prognosis

Growth phase, complications, response to propranolol.

Excellent — most involute, sometimes leaving redundant skin/telangiectasia.

Source: NICE CKS Haemangioma; DermNet