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Authors: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997. Updated 2012. Revised and updated Dr Arun Gangakhedkar, Paediatrician, Waitemata DHB, Auckland, New Zealand. Copy edited by Gus Mitchell. January 2021.
Infantile haemangioma, also known as a strawberry naevus, is the most common benign vascular skin tumour in children. It is noticed in the first few weeks of life.
Infantile haemangiomas on the face
Infantile haemangioma is found in 1–2% of newborns, and up to 10–12% at 1 year of age in Caucasian infants. It is less frequent in non-Caucasian populations. Girls are more commonly affected than boys (3:1).
Risk factors for developing infantile haemangioma include:
A placental origin for infantile haemangioma is suggested due to GLUT1 protein expression. Fetal vascular origins are proposed due to the presence of primitive marker CD133 from the fetal cardinal vein.
Defective vascular stem cell regulation involving endothelial progenitor cells (EPC), or extrinsic factors such as hypoxia and developmental vascular field disturbances can influence the development of vascular anomalies.
Infantile haemangiomas are typically solitary and most are located on the head and neck region (60%). Involvement of internal organs is usually indicated by multiple cutaneous lesions. The clinical features are determined by the depth of the lesion, distribution pattern, and phase of growth.
Infantile haemangiomas classified by depth
Distribution patterns of infantile haemangioma
Most infantile haemangiomas show rapid growth in the first 3 months with a growth arrest by about 5 months of age, receding subsequently over several years. The progression may be described in different morphological phases.
Scalp infantile haemangioma, various growth phases
Infantile haemangioma with minimal or arrested growth (IH-MAG) has an abortive or minimal growth in 25% of the lesion’s surface area, appearing as telangiectatic patches with or without papules, lacking a significant proliferative phase. This may be mistaken for a port-wine stain [see Capillary vascular malformation]. Occasionally these can be segmental with syndromic associations. Two-thirds of these lesions are seen over lower limbs.
Infantile haemangioma is usually a clinical diagnosis and investigations are not routinely indicated. Investigations may be considered if the diagnosis is uncertain, to define extent and associations, or monitor response to therapy.
Tests may include:
Differential diagnosis of infantile haemangioma
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