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Practice Practice Pointer

Infantile haemangiomas

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj-2021-068734 (Published 06 July 2022) Cite this as: BMJ 2022;378:e068734
  1. Tiernan Surlis, medical student1,
  2. Hanna De Sa Reilly, GP registrar2,
  3. Muriel Sadlier, consultant paediatric dermatologist3,
  4. Joanne Nelson, consultant paediatrician, forensic examiner, and clinical director of the Child and Adolescent Sexual Assault Treatment Service4
  1. 1School of Medicine, National University of Ireland, Galway, Ireland
  2. 2Ballinasloe Specialist Training Scheme in General Practice, Galway, Ireland
  3. 3Department of Dermatology, Children’s Health Ireland at Crumlin, Dublin, Ireland
  4. 4Saolta University Healthcare Group and School of Medicine, National University of Ireland, Galway, Ireland
  1. Correspondence to J Nelson joannek.nelson@hse.ie

What you need to know

  • Most infantile haemangiomas are small, harmless, and resolve without treatment

  • Treatment is indicated for lesions that have potential to cause functional impairment (to vision, breathing, feeding, or by compression of internal organs), ulceration, or cosmetic disfigurement

  • Refer children with high risk haemangiomas promptly, as most rapid growth occurs in the first two months of life

  • Oral propranolol is recommended to treat problematic infantile haemangiomas

Infantile haemangiomas are the commonest vascular tumour of childhood. They occur in 5% to 10% of babies.1 Most require no treatment; however, referral to secondary care may be indicated depending on the clinical scenario. This article offers an approach to assessing a child with an infantile haemangioma in primary care.

Characteristics

Infantile haemangiomas generally follow a very predictable course. They are usually not present at birth (although precursor lesions may be present), and develop in the first weeks of life.2 Lesions grow rapidly in the first three months of life, especially at 5-8 weeks. Growth is usually complete by time the infant is 6 months. This is followed by a plateau period of no growth and then gradual involution usually after the child is 1. Most haemangiomas will have completed regression by the time the child is 4. Deep haemangiomas, however, may have a prolonged growth phase and take longer to regress.23 Infantile haemangiomas occur more frequently in female and premature infants, and those of low birth weight (<1 kg).234 The risk is increased during pregnancy in women who have pre-eclampsia, advanced maternal age, multiple gestation pregnancies, progesterone therapy in pregnancy, amniocentesis, and chorionic villus sampling.567891011

Most infantile haemangiomas are small and harmless, but approximately 11% have some complications, including functional impairment, cosmetic disfigurement, and potentially serious visceral abnormalities. Rarely infantile haemangiomas can …

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