Hemangiomas are the most common tumor in neonates, affecting a percentage of them ranging between 10 to 12% in the first year of life. Hemangiomas occur in neonates after birth and tend to enlarge rapidly during the first year of life.

These tumors begin to shrink after a period of 12 to 18 months. 

About 70% of hemangiomas disappear by the time the child reaches the age of 7 years, although the skin that remains is usually slightly discolored or scarred. In neonates, hemangioma grows in or under the skin. 

They cause the skin to become bright red; if they are very deep, the skin becomes bluish. 

Most deep hemangioma grows between 0.5 and 5 centimeters in width, although they grow larger. Sometimes by a lot. More than half of these appear on the head and neck. Sometimes, hemangioma grows in organs, such as the liver.

What is hemangioma?

Hemangioma is a benign tumor resulting from the expansion and entanglement of some blood vessels. This tumor is most common in childhood, as it affects approximately 5-10% of children aged one year.

The disease develops rapidly in the postpartum period, lasting from 3 to 9 months, and then begins a stabilization period that ends with a slow tumor shrinkage and usually lasts from 18 months to 10 years.

Who do hemangiomas affect?

Hemangiomas can occur in individuals at any stage of life. 

They are frequently found in:

• Infants.
• Individuals identified as female at birth (who have a higher likelihood of developing hemangiomas compared to those identified as male at birth).
• White infants (who are more susceptible to them).
• Premature infants.
• Middle-aged adults.

What are the types of hemangiomas?

Capillary and cavernous are the two most common types of hemangiomas. 

Capillary hemangiomas:

Capillary hemangiomas manifest on the superficial layers of the skin.

• Infantile hemangiomas, also known as strawberry hemangiomas, are prevalent growths in infants, and infantile hemangioma impacts up to 12% of babies within their first year. 

They present as red protrusions on the skin, usually growing to sizes ranging from one-quarter to 2 inches. 

They tend to grow rapidly during infancy, followed by a reduction in size and coloration.

• Cherry hemangiomas, small raised red growths resembling dots, are commonly observed on the torso of adults, particularly as they age. 

Typically occurring in clusters ranging from a few to numerous growths.

Cavernous hemangiomas:

Cavernous hemangiomas develop in the deeper layers of the skin, frequently around the eye area.

Found commonly on the eyelids, the eye’s surface, or within the eye socket, cavernous hemangiomas display as clusters of broad blood vessels initially appearing dark red to blue on or beneath the skin.

These types of hemangiomas can impact eye development and contribute to vision-related issues like amblyopia, glaucoma, and cataracts.

What are the symptoms of hemangiomas?

Hemangioma symptoms vary depending on the tumor’s size and location and can differ among individuals. Nevertheless, typical indications of hemangiomas include:

• Swelling: Hemangiomas can lead to swelling at the site of impact, which may or may not be accompanied by pain.
• Pain: The affected area by hemangiomas might experience differing levels of pain. Pain may be constant or worsen with pressure or movement.
• Skin alterations: The skin covering the hemangioma might display an unusual or dark color, with a texture distinct from regular skin.
• Bleeding or displacement: Pressure exerted by the hemangioma may occasionally result in bleeding or displacement of surrounding tissue.
• Changes in organ functions: Hemangiomas can impact adjacent organ functions, manifesting as issues like breathing difficulties in case of a chest tumor or vision changes if situated in the eye.

What are the causes of hemangiomas?

Hemangiomas, though their exact cause remains mostly unknown, are believed to result from a combination of various factors and these factors include:

1. Genetic Factors: Research suggests that hereditary factors play a significant role in the occurrence of hemangiomas. 

Some families may have a history of these growths, and specific genetic mutations have been linked to an increased susceptibility to hemangiomas.

2. Hormonal Factors: Fluctuations in hormones, particularly during pregnancy, are thought to contribute to the formation of hemangiomas. 

It is common for these growths to either manifest or grow rapidly while pregnant, indicating a hormonal impact on their development.

3. Vascular Abnormalities: Hemangiomas are characterized by the anomalous growth of blood vessels. 

Irregularities in blood vessel development during fetal stages may play a part in the emergence of hemangiomas.

4. Placental Factors: Some researchers propose that factors concerning the placenta, like irregular blood flow or vascular growth, could impact hemangioma development. 

This idea is reinforced by the observation that hemangiomas frequently appear in regions of the body supplied by the placental blood flow.

5. Environmental Factors: Certain environmental elements, such as exposure to specific chemicals or toxins, may elevate the likelihood of hemangiomas. However, the precise environmental triggers for these growths have not been distinctly pinpointed.
6. Other Medical Conditions: Hemangiomas can be linked to particular medical disorders or syndromes, such as PHACE syndrome or Beckwith-Wiedemann syndrome. 

These conditions involve abnormalities in vascular development and may predispose individuals to hemangioma formation.

What is the difference between a hemangioma and a birthmark?

Hemangiomas and birthmarks, two types of skin markings, differ in appearance, development, and characteristics:

Hemangioma:

Appearance: Red or purplish lesions on the skin, hemangiomas are growths that can vary in size from small dots to larger, raised areas.

• Development: Typically appearing shortly after birth or within the first few months of life, hemangiomas grow rapidly during the initial year and then gradually shrink and disappear, a process known as involution.
• Characteristics: Composed of abnormal blood vessels, hemangiomas can be superficial (close to the skin’s surface) or deep (within deeper tissue layers), potentially causing complications like ulceration, bleeding, or obstruction of vital structures in specific locations.

Birthmark:

• Appearance: Pigmented or vascular skin markings, present at birth or develop shortly afterward with variations in size, shape, and color.
• Development: it can form during fetal development or post-birth, remaining stable or changing over time but without the rapid growth and involution stages seen in hemangiomas.
• Characteristics: Divided into two main types, pigmented birthmarks result from an overgrowth of melanocytes, while vascular stem from abnormal blood vessels. Examples include moles, café-au-lait spots, port-wine stains, and salmon patches.

How to diagnose hemangiomas?

The diagnosis is made by taking the medical history and physical examination. Ultrasound (a non-invasive diagnostic tool) can be used to confirm the diagnosis, but in many cases, there is no need for this.

In rare cases, there is a need to perform a magnetic resonance imaging (MRI) or computed tomography (CT) scan to make the diagnosis. If there is any doubt before.

If a malignant (cancerous) tumor is likely to grow, a biopsy will be performed.

It is a surgical procedure in which a small portion of the lesion tissue is removed for microscopic examination. Sometimes, the surgeon removes the entire lesion.

What is the treatment of hemangiomas?

Treatment options include monitoring, drug therapy, laser therapy, and surgical resection.

These four are the most common methods, and a combination of them can be applied if needed:

• Monitoring is usually the initial step in managing the condition. 
• When dealing with complex hemangiomas in the proliferative stage, drug treatment becomes crucial. 
• The goal of medications like Timolol, beta-blockers, corticosteroids, and others is to slow down lesion growth and reduce its size to prevent complications.
• In cases where other treatments are ineffective, medications such as Sirolimus or vincristine can be considered, but they should only be administered under the supervision of experienced medical professionals.
• Laser treatment is recommended for ulcerated hemangioma and superficial telangiectasias, as it can help with skin shrinkage but does not stop hemangioma growth. 
• Surgery is suggested for patients with painful or unhealed hemangiomas, those that affect breathing or vision, or individuals with remaining scars or deformities after treatment.

Wound care is essential for ulcerated hemangiomas to prevent complications that cause problems, which may require intensive treatment with antibiotics, laser therapy, or surgical removal. 

Each treatment option carries its risks and side effects, including skin irritation from Timolol, decreased heart rate and blood pressure from Propranolol, and side effects like irritability and stomach issues from corticosteroids.

Monitoring and managing these side effects is crucial, often requiring hospitalization for closer observation during drug administration.

What are the side effects of treatment?

Some treatments come with risks or side effects that need to be considered. 

• The use of drugs like Timolol can result in skin irritation, while Propranolol may lead to a decrease in heart rate, blood pressure, and/or blood sugar, which should be carefully monitored in a hospital setting.
• Corticosteroids, when used short-term, may cause irritability, facial swelling, stomach irritation, and sleep disturbances, but these effects typically disappear once the medication is stopped. 
• Laser therapy, if used early in treating hemangiomas, may cause scarring and changes in skin pigmentation at the site. 
• Surgery, on the other hand, may result in visible or invisible scarring and potential complications like bleeding and infection.

Finally:

In conclusion, hemangioma is characterized by the abnormal formation of blood vessels, which can manifest in various locations across the body.

While the precise etiology of hemangioma remains largely unknown, it is thought that genetic, hormonal, and vascular elements may play a role in its development. Typically emerging in early childhood, hemangiomas progress rapidly but often resolve spontaneously without intervention. 

Although generally benign, hemangioma can occasionally lead to complications such as bleeding or aesthetic impairments. 

Seeking medical advice is crucial upon observing signs of hemangioma or experiencing concerns regarding its advancement and impact on overall well-being or appearance.