Infantile hemangiomas are birthmarks that grow on your baby's skin soon after birth. If they're bright red and bumpy like a strawberry, they're called strawberry birthmarks.
Strawberry Birthmark on Babies
Strawberry birthmarks, or strawberry hemangiomas, are made of a cluster of blood vessels. Some babies may have one hemangioma, while others may have many. They can vary in size, from a few millimeters to many centimeters in diameter.
"Infantile hemangiomas are the most common benign tumor that we see in infants," says Carla Torres-Zegarra, MD, a dermatologist at Children's Hospital Colorado in Aurora. "We actually don't know exactly why they form, but we know that the tissue that is present in those infantile hemangiomas shares some markers that are also present in the placenta."
A hemangioma generally shows up soon after birth. As your child grows, blood vessels in the birthmark get growth signals, which causes them to quickly get bigger. The growth usually happens in the first five months after birth and is called the proliferative stage. By 3 months of age, their hemangioma will be about 80% of its final size. Hemangiomas can differ in size and color and show up in different places. They're benign (meaning they are not cancerous).
Usually, strawberry birthmarks shrink on their own, getting flatter and less red. For most children, strawberry birthmarks shrink by the time they're 4. But they might have scars or extra blood vessels in the spot where the hemangioma was. What's left can depend on the type of hemangioma.
The different types of hemangiomas are:
Superficial. This type is in the surface layers of your skin. It's the most common type of hemangioma. It is bright red and often called a strawberry birthmark or strawberry hemangioma because it looks like a strawberry.
Deep. A deep infantile hemangioma affects deeper layers of your skin. It's usually smooth on the surface and looks blue or skin-colored.
Mixed. This type is in both the surface and deeper layers of your skin.
Extracutaneous. These grow on your organs, bones, or in your muscles.
"A superficial hemangioma is going to leave pretty much no mark and no changes, as opposed to a deep hemangioma, where most of the growth is underneath the skin, may leave an excessive fibrofatty tissue that's kind of squishy," says Torres-Zegarra.
Strawberry Birthmark Causes
It's not clear why babies get hemangiomas. Evidence suggests they may be more likely if you have a family history of them.
Other theories suggest that certain proteins develop in the placenta that cause cells to grow quickly. At birth, these cells might spread apart. But over time, they may cluster together under your skin, forming channels with blood cells. Growth signals may cause them to grow into patches.
Some babies have hemangiomas on the inside parts of their bodies, such as their:
- Thymus
- Liver
- Gallbladder
- Spleen
- Adrenal glands
- Lungs
- Pancreas
- Digestive tract
Risk factors for strawberry hemangioma
Hemangiomas are more likely in children who:
- Are girls
- Are White
- Were born prematurely
- Had low birth weight
- Had an abnormal placenta
- Were part of a twin or multiple birth
- Were born through in vitro fertilization (IVF)
"Having moms that have a history of gestational diabetes, preeclampsia, or high blood pressure," comes with increased risk, too, Torres-Zegarra says.
Sometimes, large infantile hemangiomas can happen along with a syndrome, which includes other symptoms. It's called PHACE syndrome. Each letter stands for a different part of the syndrome:
P. Stands for posterior fossa, which is part of the brain. It is abnormally formed in this syndrome.
H. Stands for hemangioma.
A. Stands for abnormal arteries in the brain or unusually large blood vessels around the heart.
C. Stands for coarctation of the aorta, which is a problem with the aorta. The aorta is a large blood vessel that carries blood from the heart to the rest of your body.
E. Stands for eye problems.
Symptoms of Infantile Hemangioma
Hemangiomas are easy to see. Some signs include:
- A raised, bumpy patch
- Appears soon after birth
- Usually bright red in color, like a strawberry
- May look blue or purple, especially on dark skin
- Grows quickly in the first few months
- Sometimes has a sore or ulcer
- May bleed sometimes
Strawberry birthmarks are on top of the skin, but some hemangiomas are under the skin. Hemangiomas near your child's eyes, ears, or nose can cause problems as they grow, such as blocking airways or affecting eyesight. Some of these marks are more purple or brown (like a bruise), especially on darker skin.
Most hemangiomas grow on a child's head and face, but they can grow anywhere.
Complications of infantile hemangiomas may affect:
- Vision
- Feeding
- Breathing
- Diapering
- Heart function
Diagnosis of Infantile Hemangioma
Your doctor will diagnose a hemangioma by examining it. They'll ask about your pregnancy and how healthy your baby is. Usually, tests aren't needed, but Torres-Zegarra recommends having hemangiomas checked by a dermatologist.
"The most important thing for people to know is to identify those in locations that are at high risk of complications to be seen by a pediatric dermatologist ideally, within the first two to three months of life, to get started on treatment," she says. "Those that are superficial and small or even deep but small in not cosmetically-sensitive areas can then be reassured that if that is the right diagnosis, then they should expect no major problems and can leave them alone."
Depending on where your child's hemangioma is, their doctor may do tests to decide if there are potential problems with their breathing, eating, or vision. In these cases, your child might have an ultrasound to see under their skin. If the birthmark is large, their doctor might do an MRI to see if the growth is affecting any other important structures.
Infantile Hemangioma Treatment
Treatment depends on the strawberry birthmark's size, location, and type. Most go away on their own and don't need treatment.
"When they're small and superficial or fully deep, but not in high-risk locations, we just watch because we know that 90% will be gone by age 9 and 50% by age 5," Torres-Zegarra says. "So, we don't do anything with them. However, there are what are called high-risk infantile hemangiomas, which are those that can develop complications or that can lead to significant anatomical dysfunction."
Your child's strawberry birthmark may need treatment if:
- It grows near the nose, eyes, or mouth and begins to cause problems or interfere with vital functions.
- The skin starts to break down.
- Sores form on the skin.
- It's very large and will cause problems with growth.
- It's on an internal organ and causes problems.
- It hurts.
There are different treatment options, including:
Beta-blockers. If your baby needs treatment, it's most likely that you'll use a beta-blocker. These help lower blood flow to the strawberry birthmark. This slows down growth and might turn it a lighter color. They include propranolol (a medicine taken by mouth) and timolol (a gel). Beta-blockers can cause side effects such as wheezing, high blood sugar, and low blood pressure.
"The treatments are most effective when we start that treatment within the rapid growth phase, so ideally within the first few weeks of life, and they don't work forever," Torres-Zegarra says. "If I have a patient with a large hemangioma that has ulcerated and has left the scar, and the baby is already a year [old], even if they come to our clinic, we wouldn't offer propranolol at that point because it would be too late. So, there is definitely a window of opportunity that is early in life."
Corticosteroids. Steroid medications can slow down the growth of your child's hemangioma. They're best used in earlier growth stages. Once the birthmark reaches its peak size, steroids don't have as much effect. Steroids can sometimes lead to side effects such as poor growth and thinning of the skin. Since propranolol was approved for hemangiomas, doctors today don't usually use steroids for infantile hemangiomas.
Interferons. These medications take a little longer to work and are only used if other treatments don't work.
Laser therapy. Your child's doctor will apply heat and light to the hemangioma to make it smaller and lighter in color. It works best when your baby is between 6 months and 1 year of age.
Surgery. Most children won't need surgery. But their doctor might suggest it depending on the location of the strawberry birthmark. The surgery may cause scarring and damage to other tissues. If surgical removal is what your child needs, their doctor might wait until they're 3-5 years old.
In the past, before the approval of propranolol, "a lot of these were surgically removed because of how bulky or big they got, or if they were causing complications," Torres-Zegarra says. "But nowadays, it's exceedingly rare that a surgery is done in these patients."
Takeaways
Strawberry birthmarks are red and bumpy hemangiomas that grow on your baby's skin soon after birth. Most don't need treatment and go away on their own. But it's best to have them looked at as soon as possible, to help with early treatment if needed and prevent complications. In rare cases, surgery is needed to remove a strawberry birthmark. Similar marks can happen in adults, and they're called cherry hemangiomas.
Strawberry Birthmark FAQs
Can adults get strawberry birthmarks?
Yes, it's possible to get these marks later in life. But they're called cherry angiomas in adults. Unlike strawberry or infantile hemangiomas, cherry angiomas don't go away. If you have one, you may get more of them over time.
Do strawberry birthmarks need to be removed?
Not usually. Most go away on their own and don't need any treatment. Medicines may sometimes help them go away faster. Sometimes, your baby's strawberry birthmark could cause problems because of its location, and surgery may be needed to remove it. But most of the time, surgery isn't necessary.
When will a strawberry birthmark stop growing?
They usually stop around the time a child turns 1. It's possible for strawberry birthmarks to grow after that age, but it's unusual. Deep hemangiomas are more likely to grow for a longer time.
When should I worry about strawberry birthmarks?
It depends. Most strawberry birthmarks aren't a threat to your child's physical health. But if they don't go away, or they leave scars or squishy tissue, they might affect your child's self-image and emotional health. Always have strawberry birthmarks checked out by your child's doctor for possible complications and treatment options, and talk to them about the best path forward.
