Infantile Hemangiomas: Understanding and Treating Strawberry Birthmarks

Infantile Hemangiomas

Hemangiomas, commonly known as strawberry birthmarks, are clusters of extra blood vessels that appear on a baby’s skin. These birthmarks can be present at birth or develop within a few weeks or months. While some may resemble rubbery, bumpy red patches, others may look like deep bruises. For new parents, witnessing the growth of a hemangioma can be a source of worry.

According to the American Academy of Pediatrics (AAP) guidelines, it is crucial to identify and monitor infantile hemangiomas as soon as they appear. This is because hemangiomas tend to change rapidly during their early stages of development. Fortunately, most hemangiomas are benign and will resolve on their own without causing any issues. However, certain hemangiomas, especially those on the face or those that are large in size, may require early treatment to prevent interference with bodily functions or permanent scarring. Thankfully, there are excellent treatment options available today that can effectively address these concerns if administered early on.

Understanding Infantile Hemangiomas

Infantile hemangiomas typically emerge within the first month after birth. Approximately 4% to 5% of all infants develop hemangiomas, with a higher prevalence among Caucasians, girls, twins, and premature or low-birth-weight babies. These birthmarks often experience a phase of rapid growth, followed by a gradual fading and flattening.

Types of Infantile Hemangiomas

  • Superficial Hemangiomas: Also known as “strawberry marks,” these birthmarks resemble the surface texture of berries. They typically start as small white, pink, or red areas on the skin, which quickly transform into bright red, raised lesions. Superficial hemangiomas can be concentrated in one area or spread out over a larger region.

  • Deep Hemangiomas: These birthmarks have a smooth surface and develop beneath the skin. They may exhibit a bluish tint and resemble bruises. Some deep hemangiomas can cause swelling of the affected skin.

  • Mixed Hemangiomas: These birthmarks consist of a combination of superficial and deep growths.

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When is Treatment Necessary?

The decision to treat a hemangioma depends on several factors, including the baby’s age, the location and rate of growth of the birthmark, the presence of symptoms such as soreness or scabbing, and the potential for medical complications or permanent skin changes.

Reasons for Treatment:

  1. Medical problems: Although rare, certain hemangiomas can interfere with vital functions depending on their location and rate of growth. Hemangiomas near the eyes, nose, or mouth can affect a child’s vision, eating, breathing, or hearing. In some cases, hemangiomas grow internally, necessitating monitoring through imaging tests.

  2. Skin breakdown: Occasionally, the skin on the surface of a hemangioma may break down and form an open sore or ulcer. This can lead to bleeding, infection, or scarring.

  3. Permanent skin changes: Even after a hemangioma has resolved, changes in skin texture or color may persist. This is of particular concern when the birthmark is located on the face, as large hemangiomas can impact growth and cause distortions in facial features.

Available Treatment Options

In cases where a hemangioma poses potential problems, various treatment approaches are available. Medications can be applied directly to the skin or administered orally to prevent further growth or facilitate shrinkage. Laser procedures or surgery may also be considered, although surgery is generally avoided during early infancy due to the increased risks associated with anesthesia.

Systemic Treatments

  • Propranolol: This beta blocker medication, commonly used to treat high blood pressure, has proven effective in treating problematic hemangiomas. It is typically administered orally and may continue until the child’s first birthday to prevent regrowth. Close observation by a healthcare provider is necessary to monitor for potential side effects and complications.

  • Oral Steroids: While oral steroids are no longer the primary treatment option, they may still be employed in select cases based on the healthcare provider’s assessment.

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Localized Treatments

  • Topical Medications: Topical creams or ointments containing beta-blockers are an effective treatment option for small, superficial hemangiomas. These medications help halt growth and can sometimes facilitate shrinkage and fading. Steroid creams may be prescribed for smaller, thinner hemangiomas.

  • Steroid Injections: For localized hemangiomas, steroid injections directly into the birthmark can help slow down growth.

Other Treatments

  • Surgery: Surgical intervention is typically reserved for smaller hemangiomas that may pose problems or for those with broken skin. However, due to the potential for scarring and the natural regression of most hemangiomas over time, early surgery is only recommended in rare cases. Surgery can also address excessive skin or scars resulting from a hemangioma, usually performed when the child is between 3 and 5 years old.

  • Laser Treatment: In certain cases, laser treatment can be beneficial in stopping bleeding or aiding the healing of hemangiomas with open sores. It can also help minimize residual redness or texture changes after the hemangioma has improved.

Remember to Seek Medical Advice

If you notice any unusual developments on your baby’s skin, it is essential to reach out to your pediatrician for evaluation. The first few well-child visits are an excellent opportunity to discuss any concerns. While most hemangiomas do not cause significant issues and will resolve on their own, prompt evaluation, monitoring, and treatment when necessary can minimize their impact on your child.


  • Q: Can infantile hemangiomas be treated at home?

  • A: It is best to consult a healthcare professional for proper evaluation and guidance on treatment options. Attempting to treat hemangiomas at home without medical supervision can be risky.

  • Q: Do all hemangiomas require treatment?

  • A: No, most hemangiomas are harmless and will resolve on their own without intervention. However, assessment by a healthcare provider is necessary to determine if treatment is required.

  • Q: Are there any natural remedies for hemangiomas?

  • A: While some anecdotal reports suggest the use of natural remedies, it is crucial to consult a healthcare professional before considering alternative treatments. They can provide appropriate advice based on your baby’s specific situation.

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Understanding infantile hemangiomas is essential for parents to identify and address these birthmarks effectively. While most hemangiomas are benign and resolve without causing any issues, some may require medical intervention. With the advances in treatment options available today, healthcare providers can offer appropriate care to ensure hemangiomas have minimal impact on a child’s well-being.

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