Hemangioma of skin
HEMANGIOMA OF SKIN
HEMANGIOMA OF SKIN DEFINITION
A congenital vascular malformation consisting of a benign tumor made up of newly formed blood vessels clustered together; it may bepresent at birth in various parts of the body, including the liver and bones. In the majority of cases it appears as a network of small blood filled capillaries near the surface of the skin, forming a reddish or purplish birthmark.
Cavernous hemangioma a congenital vascular malformation that has a soft, spongy consistency and may contain a large amount ofblood. It usually appears during the first few postnatal weeks and disappears by the age of 9 years. The most common sites are head,neck, and viscera such as the liver, spleen, or pancreas. Treatment varies according to the size of the lesion.
Strawberry hemangioma a circumscribed capillary hemangioma, which may be present at birth or may appear soon after birth. These aremost common on the head, neck, and trunk and appear as small macules that develop into raised purplish-red lobulated tumors. Mostinvolute by age 2 to 3.
HEMANGIOMA OF SKIN CAUSES
A hemangioma consists of an abnormally dense group of extra blood vessels. It’s not clear what causes the blood vessels to group together, although there may be a hereditary component involved.
HEMANGIOMA OF SKIN PATHOPHYSIOLOGY
Infantile hemangiomas are composed of proliferating, plump endothelial cells. Early in proliferation, the cells are in disarray, but, with time, they form vascular spaces and channels replete with blood cells.
These benign-appearing endothelial cells produce limited basement membrane structures. Hemangiomas assume a lobular architecture as proliferation slows and ends. Mast cells appear to affect this process and are implicated in the promotion of feeding arterioles and veins that supply each lobule. They also have been found in high concentrations during involution.
Takahashi hypothesized that during the third trimester of fetal development, immature endothelial cells coexist with immature pericytes, which maintain their proliferative capacity for a limited period during postnatal life. Angiogenic peptides, such as beta-fibroblast growth factor, vascular endothelial growth factor (VEGF), and proliferating cell nuclear antigen, induce proliferation of these immature cells, resulting in the development of the hemangioma. As the endothelial cells differentiate, an influx of mast cells, various myeloid cells, and tissue inhibitors of metalloproteinases (TIMPs) occurs. TIMPs, along with interferon and transforming growth factor produced by the mast cells, terminate the endothelial cell proliferation and passively induce involution by senescence of endothelial cells.
HEMANGIOMA OF SKIN SYMPTOMS
A hemangioma may be present at birth, but more often appears during the first several months of life. It starts out as a flat red mark anywhere on the body, most often on the face, scalp, chest or back. Usually a child has only one mark, but some children may have more than one, particularly if they’re part of a multiple birth.
During your child’s first year, the red mark grows rapidly and becomes a spongy mass that protrudes from the skin. The hemangioma then enters a rest phase and, eventually, it begins to slowly disappear.
Half of all hemangiomas resolve by age 5, and nearly all hemangiomas are resolved by age 10. Although the color of the birthmark also fades, faint — but permanent — discoloration of the skin or residual extra skin may remain.
HEMANGIOMA OF SKIN DIAGNOSIS
Your ophthalmologist (EyeYour ophthalmologist (Eye M.D.) can diagnose hemangiomas based upon their appearance. Additional testing is usually not necessary.
HEMANGIOMA OF SKIN TREATMENT
The majority of hemangiomas never need any form of treatment. Some parents feel that hemangioma treatment is necessary because the marks can be disfiguring and may cause social or psychological problems. Doctors, however, may be hesitant to treat a hemangioma that isn’t causing physical problems because hemangiomas usually fade gradually without treatment, and because treatments have potential side effects.
If the growth interferes with your child’s vision or causes other problems, treatment options may include:
- Corticosteroid medications. Corticosteroids can be injected into the nodule, given by mouth or applied to the skin. Side effects can include poor growth, high blood sugar, high blood pressure and cataracts.
- Laser surgery. Lasers can stop the growth of a hemangioma. Sometimes lasers can be used to remove a hemangioma or treat sores on a hemangioma that won’t heal. Side effects include pain, infection, bleeding, scarring and changes in skin color.
Research to find other treatments with fewer side effects is ongoing. Some newer, though still experimental, treatments include beta blockers, interferon alfa and topical immune suppressants.
If you’re considering treatment for your child’s hemangioma, weigh the pros and cons with your child’s doctor. Remember, most infantile hemangiomas disappear on their own during childhood.