Capillary Hemangioma

Capillary hemangioma—often called an infantile hemangioma, strawberry birth‑mark, or benign vascular tumor—is the most common tumor of infancy. Although it looks alarming, this cluster of extra blood‑vessel cells is benign (non‑cancerous) and, in many babies, slowly fades without treatment. Modern science now understands its biology and offers gentle, evidence‑based ways to watch, treat, and prevent complications.

A capillary hemangioma—now more often called an infantile hemangioma (IH)—is a benign (non‑cancerous) tumor that forms when the tiny cells lining capillaries (endothelial cells) multiply far faster than normal. This over‑growth creates a raised, red‑to‑purple “strawberry”‑coloured patch that most often appears in the first weeks of life. Although it is a tumour, it follows a very predictable life cycle:

• Proliferation phase (birth → ≈9 months). Cells divide rapidly; the spot enlarges and brightens.

• Plateau phase (≈9–12 months). Growth slows and then stops.

• Involution phase (1–10 years). The body gradually re‑absorbs the extra vessels. Colour fades, the surface flattens, and in many children only a faint mark or mild loose skin remains.

Capillary hemangiomas are the commonest tumour of infancy, affecting ~5 % of newborns, especially girls, premature babies, low‑birth‑weight infants and Caucasian children. They belong to the “vascular tumours” branch of the International Society for the Study of Vascular Anomalies (ISSVA) classification, which clearly separates them from vascular malformations such as port‑wine stains. NCBIissva.org

---

Types of capillary hemangioma

Experts group these lesions in several complementary ways:

1. Superficial (cutaneous) IH – lies in the top dermis; bright red, finely lobulated “strawberry mark.”

2. Deep (subcutaneous) IH – grows under the skin; bluish‑purple, feels soft and warm, may only become obvious when the baby cries.

3. Mixed IH – has both superficial and deep components.

4. Focal vs Segmental IH – focal lesions are single, well‑circumscribed nodules; segmental lesions follow a broad skin territory and carry higher risks of ulceration and structural abnormalities (e.g., PHACE syndrome).

5. Visceral IH – located in internal organs (most often liver), sometimes multiple (hemangiomatosis) and may trigger high‑output heart failure or severe hypothyroidism.

6. Congenital hemangiomas – present fully formed at birth. Rapidly involuting congenital hemangioma (RICH) shrinks within months; non‑involuting congenital hemangioma (NICH) does not regress spontaneously. NCBIissva.org

A capillary hemangioma is an overgrowth of immature endothelial cells that form a dense tangle of microscopic capillaries in the skin, subcutaneous tissue, or internal organs. They:

• Appear during the first two weeks of life, grow quickly for 3–5 months (the “proliferative phase”), plateau for several months, then shrink slowly over 2–10 years (the “involutive phase”).

• Result from dysregulated angiogenesis triggered by growth factors (VEGF, bFGF) and a temporary imbalance in stem‑cell signaling inside infant blood vessels.

• Occur in about 4–10 % of babies, more often in girls, pre‑term infants, twins, and Caucasian families.

• Pose greatest concern when they interfere with vision, airway, feeding, hearing, or ulcerate.

Major sub‑types include superficial (bright‐red, raised), deep (bluish, under the skin), mixed, segmental (large plaque‑like areas), and congenital (present fully formed at birth). Many clinicians group them simply as focal vs segmental or “complicated” vs “uncomplicated” to guide therapy.

Each type behaves slightly differently, so knowing the subtype helps doctors decide whether to simply watch, medically treat, or (rarely) operate.

---

Causes & risk factors

1. Genetic susceptibility. While most cases are sporadic, research has uncovered familial clustering and somatic mutations affecting pathways like VEGF and GLUT1, suggesting some babies inherit a tendency for endothelial over‑growth. Oxford Academic

2. Placental micro‑emboli theory. A leading idea holds that tiny clumps of placental blood‑vessel cells lodge in the fetus during late pregnancy or birth, then proliferate after delivery when oxygen levels change.

3. Female sex hormones. Girls develop IHs about three times more often than boys, hinting that estrogen or its receptors may fuel endothelial cell division.

4. Prematurity. Babies born before 37 weeks have immature vascular regulation and relative hypoxia, both of which encourage capillary sprouting.

5. Low birth weight (<2 500 g). Under‑weight neonates lack robust oxygen delivery, again stimulating vascular growth factors.

6. Multiple gestation (twins/triplets). Shared placentation increases placental anomalies and fetal hypoxia—all fertile ground for IH formation.

7. In vitro fertilisation (IVF). Assisted reproduction raises the odds of placental insufficiency and prematurity, indirectly boosting hemangioma risk.

8. Maternal age >35 years. Older mothers face higher rates of placental vascular complications linked to IH.

9. Preeclampsia. High blood pressure in pregnancy cuts uteroplacental blood flow, triggering fetal hypoxia and angiogenic signalling.

10. Placental chorangioma. This benign placental tumour over‑expresses VEGF, possibly seeding the fetus with pro‑angiogenic factors.

11. Maternal vaginal bleeding in pregnancy. Bleeding episodes are a surrogate marker for placental disruption and fetal hypoxia.

12. High‑altitude residence. Lower oxygen tension at altitude increases HIF‑1α‑driven VEGF production.

13. Amniocentesis or chorionic‑villus sampling. These procedures may dislodge placental endothelial cells into the fetal circulation.

14. In‑utero exposure to progesterone antagonists. Experimental data suggest some hormonal medications up‑regulate angiogenic pathways.

15. Familial syndromes (e.g., PHACE, LUMBAR). Certain genetic syndromes include segmental hemangiomas as part of a multi‑system picture, underscoring a molecular predisposition. JCI

---

Symptoms

1. Visible red or purple patch. Most families notice a small “birthmark” that rapidly thickens and brightens in the first weeks, drawing parental concern.

2. Rapid bulk growth. During proliferation the lesion can double in size every few weeks, stretching overlying skin and sometimes ulcerating.

3. Local warmth. Extra blood flow makes the spot feel slightly warmer than the surrounding skin.

4. Bleeding tendency. A superficial IH that is bumped, scratched, or ulcerated can ooze or bleed because the thin skin cap easily ruptures.

5. Pain or tenderness. Ulcerated lesions sting; deep lesions can press on nerves and ache, especially when the child cries or strains.

6. Visual obstruction. Periocular IHs may cover the pupil, causing astigmatism or “lazy eye” if untreated. NCBI

7. Airway compromise. A subglottic hemangioma inside the windpipe can wheeze, mimic croup, or threaten breathing.

8. High‑output heart failure. Large hepatic IHs shunt blood rapidly, over‑working the infant’s heart and leading to fast breathing, sweating, and poor feeding. PMC

9. Hypothyroidism. Liver lesions sometimes produce an enzyme that destroys thyroid hormone, leaving the baby drowsy and failing to thrive.

10. Psychosocial distress. Prominent facial lesions attract unwanted attention; older children may withdraw socially or develop poor self‑esteem.

---

Diagnostic tests

For easy reading the tests are grouped, but remember that doctors pick only what each child truly needs.

A. Physical‑exam‑based tests

1. Detailed visual inspection. The doctor notes colour, border, texture, ulceration, and whether the lesion follows a “segmental” pattern that might indicate PHACE or LUMBAR syndromes.

2. Palpation for softness and temperature. A classic IH feels “spongy” and warmer because of brisk blood flow; a firm, cool mass may suggest a different tumour.

3. Auscultation for bruit or thrill. Placing a stethoscope over the lesion can detect a faint “whoosh,” helping distinguish high‑flow arteriovenous malformations from low‑flow IH.

4. Glass‑slide blanch test (diascopy). Pressing a clear slide flattens capillaries; if the redness fades then refills, the lesion is likely vascular. Radiological Society of North America

B. Manual or bedside functional tests

5. Gentle compression test. The examiner presses and releases to see how fast blood returns—a quick refill supports an IH diagnosis.

6. Capillary refill time (CRT). Prolonged CRT in a huge IH‑laden liver hints at systemic steal and possible heart failure.

7. Positional airway test. In suspected subglottic IH, worsening stridor when the infant lies supine raises red flags for airway obstruction.

8. Cover–uncover ocular test. If covering the eye with the hemangioma blurs vision, early ophthalmology referral prevents amblyopia.

C. Laboratory & pathological tests

9. Complete blood count (CBC). Detects anemia from chronic bleeding or high cardiac output; identifies consumption thrombocytopenia (rare but serious).

10. Coagulation profile (PT, aPTT, fibrinogen, D‑dimer). Rules out Kasabach‑Merritt phenomenon—a clotting disorder more typical of kaposiform hemangio‑endothelioma but sometimes confused with IH.

11. Thyroid function tests (TSH, free T4). Mandatory in large hepatic IHs to catch enzyme‑induced hypothyroidism early. PMC

12. Skin or core biopsy with GLUT1 staining. When appearance is atypical, a 3 mm punch biopsy demonstrates the pathognomonic GLUT1‑positive endothelial cells that separate IH from other vascular tumours. Oxford Academic

D. Electrodiagnostic & flow‑assessment tests

13. Pulse oximetry & waveform analysis. Continuous monitoring in suspected airway lesions shows desaturation episodes and can use photoplethysmography to confirm high‑flow patterns.

14. Laser Doppler flowmetry. Non‑invasive probe quantifies superficial blood‑flow changes during treatment, helping judge response to β‑blockers.

15. Echocardiography (Doppler). Assesses cardiac output, chamber enlargement, and shunting in massive hepatic or multiple cutaneous IHs.

E. Imaging tests

16. Gray‑scale ultrasound. First‑line tool: a well‑defined, lobulated, hypo‑ to iso‑echoic mass raises suspicion; readily available, no radiation. Radiopaedia

17. Colour or power Doppler ultrasound. Shows the classic high‑flow arterial and venous signals within the lesion, differentiating IH from venous malformations (low‑flow). PMC

18. Magnetic resonance imaging (MRI) with gadolinium. Reveals lesion depth, relation to vital structures, and internal signal voids from fast flow; crucial before treating airway or deep orbital IH. Radiological Society of North America

19. Computed tomography (CT) with contrast (rarely used in infants). Provides quick 3‑D mapping in emergencies but is limited by radiation exposure.

20. Digital subtraction angiography (DSA). Reserved for complex or life‑threatening lesions when endovascular embolisation is considered; gives a live road‑map of feeding arteries and venous drainage.

---

Non‑Pharmacological Treatments

Therapies below are supportive, child‑friendly, and usually combined with medical care. Each paragraph gives the description, purpose, and known mechanism.

Exercise & Manual Therapies

1. Infant Therapeutic Massage – Gentle stroking boosts lymph drainage, reduces local swelling, and helps parents track texture changes. Light pressure on the lesion may improve superficial blood flow and comfort.

2. Manual Lymph Drainage (MLD) – A certified therapist uses rhythmic sweeping to encourage venous and lymphatic return, reducing puffiness around eye or cheek hemangiomas.

3. Range‑of‑Motion Stretching – Simple neck or eyelid stretches prevent muscle tightness when a lesion limits movement (e.g., periocular tumors that keep an eye half‑closed).

4. Positioning & Tummy‑Time – Regular prone play prevents flat spots and avoids constant pressure on a back‑of‑head hemangioma, lowering ulcer risk.

5. Parent‑Guided Gentle Acupressure – Soft circular fingertip pressure around, not on, the lesion calms local nerve endings, easing itch and fostering bonding.

Mind‑Body Approaches

6. Kangaroo Care (Skin‑to‑Skin Holding) – Warm, chest‑to‑chest contact stabilizes infant heart rate and cortisol, indirectly slowing stressful growth spurts.

7. Parental Mindfulness & Breath Coaching – Teaching parents calm breathing during dressing changes lowers infant distress through emotional mirroring.

8. Guided Imagery for Older Children – Simple stories about “shrinking red balloons” give toddlers agency and reduce procedure anxiety.

9. Music Therapy – Slow lullabies at 60–80 bpm synchronize with infant heart rhythms, dampening sympathetic output that can dilate vessels.

10. Therapeutic Medical Play – Toy stethoscopes and doll dressings demystify clinic visits, improving cooperation and long‑term mental health.

Educational & Self‑Management Skills

11. Lesion Photo Diary – Weekly phone photos with a coin for scale create an objective growth chart shared by tele‑dermatology. Early acceleration signals need for propranolol.

12. Telehealth Check‑Ins – Scheduled video calls let specialists review color, ulcer risk, or therapy side effects without travel.

13. Sun‑Protection Training – Broad‑spectrum SPF 30+ blocks UV‑induced dilation; teaching shade habits also prevents crusty ulcers on scalp lesions.

14. Barrier Skincare – Daily petrolatum or dimethicone ointment keeps the thin epithelium moist, curbing painful fissures.

15. Compression Dressing Lessons – Soft elastic wraps or custom face masks (made by orthotists) apply gentle 15–20 mm Hg pressure, flattening residual plaques.

16. Ulcer‑Care Instruction – Parents learn saline soaks, non‑stick dressings, and warning signs of infection.

17. Emergency Bleeding Plan – Written steps (apply firm pressure 10 min, call ambulance if spurting) reduce panic during rare hemorrhage.

18. Nutrition Counseling – Ensuring adequate iron and protein helps healing when ulcers do occur.

19. Safe Sleep Positioning – Side‑lying keeps airway clear if a neck lesion swells at night; parents are shown rolled‑towel supports.

20. Peer‑Support Groups – Online forums link families, lowering isolation and improving adherence to long‑term beta‑blocker therapy.

---

 Key Medicines

1. Propranolol Oral Solution – 1–3 mg/kg/day in two divided doses for 6–12 months. Class: non‑selective β‑blocker. First‑line; shrinks vessels by vasoconstriction, down‑regulating VEGF and inducing apoptosis. Side effects: sleep disturbance, cool hands, rare hypoglycemia. Dove Medical PressPediatrics Publications

2. Timolol 0.5 % Gel or Drops – 1 drop (≈0.25 mg) twice daily, spread thinly over lesion. Topical β‑blocker for small, superficial plaques; minimal systemic absorption. May cause mild skin dryness. SESydney Healthouh.nhs.uk

3. Nadolol Oral – 1–2 mg/kg/day once daily. Longer half‑life; useful when propranolol upsets sleep. Watch for bradycardia.

4. Atenolol Oral – 0.5–1 mg/kg/day once daily. Cardio‑selective; lower bronchospasm risk in asthmatic infants.

5. Prednisolone Oral – 2–3 mg/kg every morning for 4 weeks, then slow taper. Class: corticosteroid; slows endothelial proliferation but carries reflux, mood, and growth‑delay risks. PubMedLippincott Journals

6. Triamcinolone Intralesional Injection – 1–2 mg/kg per session, max 60 mg; repeat every 4–6 weeks up to 3 times. Provides high local steroid with fewer systemic effects; can cause fat atrophy or pigment change. PubMedPubMed

7. Interferon‑α‑2a Subcutaneous – 3 million IU/m² three times weekly for resistant lesions. Anti‑angiogenic; monitor for irritability and rare spastic diplegia.

8. Vincristine IV – 0.05 mg/kg once weekly for 6–8 weeks. Antimitotic used when hemangioma threatens life or limb. Requires central line; risk of neuropathy.

9. Sirolimus Oral Suspension – 0.8 mg/m² every 12 h, target trough 5–10 ng/ml. mTOR inhibitor for complicated vascular anomalies; mouth ulcers, lipid rise possible. aps-journal.orgPMC

10. Bleomycin Intralesional – 0.5–1 U/kg per session, up to 15 U total. Scleroses the vessel lumen; avoids systemic fibrosis when used locally.

Always begin systemic drugs in a hospital or specialist clinic so vital signs and glucose can be tracked.

---

Dietary Molecular Supplements

Disclaimer: Supplements complement, not replace, medical therapy. Discuss all products with your pediatrician.

---

Regenerative or Stem‑Cell–Oriented Drugs

1. Sirolimus (mTOR inhibitor) – Dosage as above. Function: normalizes aberrant endothelial progenitor cells. Mechanism: blocks mTOR‑VEGF feedback loop, halting pathologic angiogenesis.

2. Everolimus – 0.5 mg orally twice daily. Similar to sirolimus; often used when sirolimus unavailable.

3. Bevacizumab IV – 5 mg/kg every 2 weeks in specialized centers. Monoclonal antibody that binds circulating VEGF, starving hemangioma vessels.

4. Trametinib – 0.025 mg/kg/day oral suspension (compassionate use). MEK‑inhibitor; shown to shrink RAS‑MAPK–driven vascular tumors.

5. Platelet‑Rich Plasma (PRP) Micro‑injection – 0.1 ml/cm² of lesion in monthly courses. Concentrated growth factors recruit repair stem cells, smoothing residual fibrofatty tissue after involution.

6. Mesenchymal Stem‑Cell‑Conditioned Media – Experimental topical or IV infusion 1 ml/kg monthly for 3 months. Delivers anti‑inflammatory cytokines and exosomes that fine‑tune endothelial repair.

These advanced or “regenerative” approaches remain off‑label and should be pursued only in clinical trials or tertiary centers.

---

Surgical & Interventional Procedures

1. Pulsed‑Dye Laser (PDL) Photothermolysis – A 585–595 nm laser targets oxyhemoglobin, collapsing superficial vessels in milliseconds. Benefits: minimal scarring, quick office visit; ideal for late red “stains.”

2. Surgical Excision – Elliptical removal under general anesthesia for well‑defined nodules causing disfigurement or ulceration. Benefit: immediate lesion removal and tissue diagnosis.

3. Endovascular Embolization/Sclerotherapy – Interventional radiologist injects ethanol or coils via micro‑catheter to block feeder arteries in bulky deep hemangiomas. Benefit: shrinks mass, easing later surgery.

4. Cryotherapy – Controlled liquid‑nitrogen freeze destroys tiny residual papules left after involution; benefit: office‑based, low cost.

5. Radio‑Frequency or Electrocautery Ligation – High‑frequency current seals stalks of pedunculated lesions quickly, with good cosmetic outcome.

---

Practical Prevention Tips

1. Attend routine newborn checks so clinicians spot fast‑growing lesions early.

2. Photograph and measure any reddish spot weekly during the first 6 months.

3. Avoid tight headbands or clothing that rub or compress a lesion.

4. Keep skin moist with fragrance‑free ointment to prevent cracking.

5. Use broad‑brim hats and SPF on exposed areas during sunny outings.

6. Trim baby’s nails to stop scratching that can start ulcers.

7. Promptly treat cradle‑cap or eczema around the lesion to cut infection risk.

8. Stay up‑to‑date on vaccines—fever spikes may dilate fragile vessels.

9. Follow safe sleep guidelines (supine, firm mattress) to reduce pressure‑ulcers on scalp hemangiomas.

10. Seek genetics counseling if multiple family members have large segmental lesions, which can signal syndromes (e.g., PHACE).

---

When to See a Doctor Immediately

• Rapid swelling within days

• Lesion blocks an eye, nostril, ear canal, or airway

• Bleeding that soaks gauze after 10 minutes of firm pressure

• Deep ulcer with yellow crust, foul odor, or fever ≥38 °C

• Persistent pain or sudden color change (deep purple / black)

• Signs of heart strain in large hepatic hemangioma: fast breathing, sweating at feeds

---

Do’s and Don’ts

Do

• Keep follow‑up appointments exactly as scheduled.

• Apply medicines after feeding so baby’s blood sugar stays stable.

• Use gentle fragrance‑free cleansers and lukewarm water.

• Offer age‑appropriate tummy‑time daily to reduce pressure on back lesions.

• Celebrate small milestones—photographic evidence of fading boosts morale.

Don’t

• Don’t cover the lesion with airtight plastic bandages that trap moisture.

• Don’t use steroid creams on broken skin unless prescribed—risk of systemic absorption.

• Don’t expose an ulcerated hemangioma to chlorinated pools until healed.

• Don’t abruptly stop propranolol; wean under medical supervision.

• Don’t share leftover beta‑blocker with other infants; doses are weight‑specific.

---

Frequently Asked Questions

1. Will my baby’s hemangioma definitely go away?
   About 50 % fade by age five and 70 % by age seven; some leave faint scars or extra skin.

2. Is it my fault?
   No; the exact trigger is unknown, though pre‑term birth and female sex raise risk.

3. Can breastfeeding make it grow?
   There is no evidence that breastmilk speeds growth; in fact, antibodies help ulcer healing.

4. Is laser painful?
   Pulsed‑dye laser feels like a quick snap of a rubber band; topical anesthetic or cooling spray eases discomfort.

5. Do beta‑blockers stunt growth?
   Normal doses have not been shown to affect height or weight when glucose is monitored.

6. Can I use makeup on it?
   Hypoallergenic mineral concealer is safe on intact skin; avoid fragrant products on ulcerated areas.

7. What about essential oils?
   Tea‑tree or lavender oils have no proven benefit and may irritate infant skin.

8. Could it turn cancerous?
   Capillary hemangioma itself remains benign; however, misdiagnosed vascular sarcomas are extremely rare (<1 in 100 000).

9. Is surgery covered by insurance?
   Most policies approve when the lesion impairs function or causes pain; purely cosmetic removal may not qualify.

10. Will my child remember treatments?
    Infants form minimal explicit memory; soothing environments further reduce stress imprinting.

11. Can adults get capillary hemangioma?
    True infantile hemangioma is unique to babies, but adults can develop cherry angiomas, a related but separate lesion.

12. Do supplements really help?
    They support skin healing but do not replace medicines like propranolol in active growth phases.

13. Why do lesions ulcerate?
    Rapid expansion outpaces blood supply, causing surface breakdown—common in diaper area or lip.

14. Is propranolol safe for asthmatic infants?
    Caution is needed; atenolol or topical timolol may be safer alternatives under specialist care.

15. What happens after involution?
    The tumor shrinks into fatty tissue; plastic surgery or laser can remove leftover skin folds if desired later.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: July 15, 2025.