Strawberry Birthmarks in Babies: Understanding Infantile Hemangioma
- MedReport Foundation
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Introduction
Infantile hemangioma (IH) is a non-cancerous growth made of abnormal blood vessels. They
usually appear in infants shortly after birth. These are also known as “strawberry birthmarks”
due to their characteristic bright red colour. Even though they look concerning, most infantile
hemangiomas are harmless, and they resolve on their own without any treatment.(1)
What Is Infantile Hemangioma?
Infantile hemangioma is a type of non-cancerous tumour seen in newborns. It develops due
to the abnormal growth of cells that line the blood vessels, called the endothelial cells.(2)
It is the most common type of vascular tumour seen in infancy, which affects about 5 to 10%
of newborn babies.(3)
Appearance and Location of Infantile Hemangioma
They usually appear within the first few weeks after birth as small red or bluish patches on
the surface of the skin or under the skin. The size of infantile hemangiomas can range from
a few millimetres to several centimetres.(4)
They mostly appear on the head, neck, and limbs, but in some cases, they can also develop
inside the body.(2)
Growth Stages of Infantile Hemangioma
Infantile hemangiomas show a unique growth pattern compared to other vascular tumours
and malformations. This characteristic growth pattern helps to distinguish them from other
vascular conditions.
The growth pattern consists of two phases:
1. Proliferative Phase or Growth Phase
The initial stage of tumour growth is called the proliferative phase. During this stage, the
tumour undergoes rapid growth and increases in size. This process can last for a few
months.
2. Involution Phase or Shrinking Phase
This is the second stage of tumour growth, where the lesion stops growing and becomes
stable. Then, it gradually begins to shrink and flatten after some time. This process can take
several years.(3)
Most cases of infantile hemangiomas resolve on their own by early childhood without
causing any health problems.
Types of Infantile Hemangioma
Infantile hemangiomas can be classified into two types based on:
➔ How deep they are in the skin
➔ How they are distributed throughout the body
Based on the depth of the tumour:
● Superficial: These are the most common type, and they appear as bright red lesions
raised above the skin.
● Deep: These develop deep under the skin and appear as bluish coloured lump with
or without the presence of small dilated blood vessels (telangiectasia/spider veins).
● Compound: These show characteristic features of both superficial and deep
hemangiomas, involving both the surface and deeper layers of the skin.
Based on distribution pattern of the tumour:
● Focal: These lesions are well-defined and appear to develop from a single central
point. These are the most common type, making up about 68% of cases.
● Multifocal: In this type, several lesions appear in multiple areas of the body.
● Segmental: These are broad, plaque-like patches, that cover larger areas of skin.
These are less common (about 13%) but more likely to cause complications.
● Indeterminate: These do not fit into focal or segmental types, and they account for
about 17% of cases.(3)
Possible Complications of Infantile Hemangioma
Most infantile hemangiomas do not cause any problem, but in rare cases, depending on the
size and location of the tumour it can lead to following complications.
Ulceration
It is the most common complication of infantile hemangiomas. It usually occurs when a
tumour develops in areas that are under constant friction or pressure. These ulcers can
cause severe pain and may lead to bleeding, infection, and scarring.
Airway obstruction
Hemangiomas in certain locations, such as the jaw, chin, and neck regions, can cause
breathing problems by blocking the airway.
Visual impairment
Lesions near the eyes may affect normal vision by causing conditions such as astigmatism,
visual axis obstruction, nasolacrimal duct obstruction, drooping eyelids, and misalignment of
eyes.
Conductive hearing loss
Hemangiomas near the ear canal may lead to potential hearing issues.
Internal organ damage
In rare cases, hemangiomas can form inside the body and may affect major organs.
Depending on the organ involved, this may lead to complications such as heart failure,
hypothyroidism, gastrointestinal bleeding, increased abdominal pressure, obstructive
jaundice or neurological problems.(3,4)
Risk Factors for Infantile Hemangioma
The exact cause of infantile hemangioma is not fully understood. But several factors have
been identified that increase the risk of developing this condition.
Common Risk Factors are as follows:
● Low birth weight
● Premature birth
● Female sex
● Caucasian ethnicity
● Family history of infantile hemangioma
Having one or more risk factors does not mean a child will definitely develop hemangioma,
but they may increase the likelihood.(3)
How is Infantile Hemangioma Diagnosed?
In most cases, infantile hemangiomas are diagnosed by conducting a physical examination
and by collecting medical history of both the mother and infant.
In some cases, infantile hemangioma can be difficult to identify, such as the ones that form
under the skin or those without any characteristic skin changes. These hemangiomas may
look similar to other vascular conditions. In such cases, additional diagnostic imaging, such a
high-frequency ultrasound, CT scan or MRI scan may be required.
A biopsy is rarely needed. But in extremely rare cases, a biopsy might be done to check the
presence of a marker called glucose transport protein-1 (GLUT-1). This marker helps to
distinguish infantile hemangioma from other vascular conditions.(4)
How is Infantile Hemangioma Treated?
Most uncomplicated infantile hemangiomas do not require any treatment. They usually stop
growing and start to shrink on their own when the child reaches around 12 months of age.(3)
High-risk hemangioma can interfere with normal body functions, cause permanent
disfigurement, and may lead to complications. In such cases, early treatment is required and
ideally it should be started as early as 4 to 6 weeks after birth.(3)
The treatment approach should be individualized based on factors such as size and location
of the tumor stage of tumor growth, risk of permanent scarring, age of the child, and
possible complications. This is done to minimize complications and to improve treatment
outcomes.(4)
Treatment Options
Beta-Blockers
Beta-blockers are the first-line treatment for infantile hemangiomas due to their high efficacy.
They can be applied directly on the skin or taken by mouth.
● Oral beta-blockers are mostly used for high-risk or complicated cases. E.g.
Propranolol
● Topical beta-blockers are used for treating thin surface hemangiomas and small
ulcers. They are also used for reducing rebound hemangioma growth in children after
oral beta- blocker treatment. E.g. Timolol
Corticosteriods
Corticosteriods were considered as first-line therapy against infantile hemangiomas before
beta-blockesr became the first choice. They are now mainly used to treat complicated
hemangiomas, where beta-blockers cannot be used.
Laser Therapy
The most commonly used laser for treating infantile hemangiomas is the pulsed dye laser
(PDL). It is mainly used to treat small surface hemangiomas, ulcers, and leftover scars.
In the case of larger hemangiomas, laser therapy may be used in combination with
beta-blockers for better treatment results. For deep hemangiomas, the Nd:YAG laser may be
used, while a combination of Nd:YAG laser and PDL can be used for mixed infantile
hemangiomas.
Surgery
Surgery is usually done for removing the scarred tissue or leftover loose skin after the
hemangioma has disappeared. It may also be used in rare cases that are life-threatening or
when other treatment methods are not effective.(4)
When Should Parents See a Doctor?
The hemangioma will usually be checked by the doctor during regular follow-up visits, but
parents should seek medical advice if:
● The hemangioma is getting bigger in size.
● It is located near the eyes, nose, mouth, or throat.
● There is pain, bleeding, ulceration, or signs of infection.
● It affects breathing, feeding, hearing, vision,or normal movement of the baby.
● There are several hemangiomas on the body.
Conclusion
Infantile hemangiomas are common non-cancerous growths that appear during early
infancy. Most hemangiomas are harmless and go away on their own without treatment. But
some may need medical care to prevent possible complications. Identifying the condition
early and providing proper care can help to achieve better outcomes in affected children.
References
1. Leonardi‐Bee J, Batta K, O’Brien C, Bath‐Hextall FJ. Cochrane Review:
Interventions for infantile haemangiomas (strawberry birthmarks) of the skin.
Evid‐Based Child Health [Internet]. 2012 [cited 2026 May 8]; 7(2):578–626. Available
from: https://onlinelibrary.wiley.com/doi/10.1002/ebch.1831 .
2. Zhu Z, Jiang X, Wang F, Zhao L, Song Q. Decoding infantile hemangioma: cellular
dynamics, molecular signals, and microenvironmental influences. Front Oncol
[Internet]. 2025 [cited 2026 May 8]; 15:1675194. Available from:
3. Tiemann L, Hein S. Infantile Hemangioma: A Review of Current Pharmacotherapy
Treatment and Practice Pearls. J Pediatr Pharmacol Ther [Internet]. 2020 [cited 2026
May 8]; 25(7):586–99. Available from:
4. Rešić A, Barčot Z, Habek D, Pogorelić Z, Bašković M. The Evaluation, Diagnosis,
and Management of Infantile Hemangiomas—A Comprehensive Review. JCM
[Internet]. 2025 [cited 2026 May 8]; 14(2):425. Available from:
