The Bottom Line

Infantile hemangiomas — commonly called strawberry birthmarks — are the most common vascular birthmarks in babies, affecting 4–5% of infants. They are benign (non-cancerous), grow rapidly in the first few months, then slowly shrink on their own. About 90% disappear by age 9 without any treatment. When hemangiomas are near the eyes, airways, or other sensitive areas, treatment with propranolol is highly effective and safe, with over 90% of treated babies showing significant improvement.

What Is an Infantile Hemangioma?

An infantile hemangioma is a benign growth made up of extra blood vessels in the skin. The nickname "strawberry birthmark" comes from the bright red, bumpy surface of superficial hemangiomas, which resembles the surface of a strawberry.

These birthmarks are actually not present at birth in most cases — they usually appear in the first 1–4 weeks of life as a faint red spot or patch. Then they grow, sometimes quickly. Hemangiomas are the most common vascular tumor of childhood.

Types of Hemangiomas

  • Superficial: Bright red, raised, bumpy — the classic "strawberry" look. Found in the top layers of skin.
  • Deep: Bluish or skin-colored, soft and compressible. Found in deeper tissue under the skin surface.
  • Mixed: Both superficial and deep components combined.

About 80% of hemangiomas are single lesions. The face and neck are the most common locations (60%), followed by the trunk (25%) and extremities (15%).

How Do Hemangiomas Develop?

Hemangiomas follow a predictable two-phase course:

Growth Phase (Proliferative Phase)

From the first weeks of life to about 3–12 months, the hemangioma grows rapidly. This is when parents are often most worried. The hemangioma reaches its maximum size during this phase.

Shrinking Phase (Involutional Phase)

After reaching peak size, the hemangioma gradually shrinks on its own:

  • 50% of hemangiomas fully resolve by age 5
  • 90% resolve by age 9
  • Nearly 99% eventually shrink without treatment

As they shrink, hemangiomas typically change color from bright red to grayish-white, then flatten and fade. Some leave a small area of loose or pale skin after full regression — especially larger lesions.

When Is Treatment Needed?

Most hemangiomas can be safely monitored without treatment. However, some need early intervention:

  • Near the eye: Can block vision and lead to permanent vision problems (amblyopia) if not treated
  • On the tip of the nose, lip, or ear: Rapid growth can distort these structures
  • Large facial hemangiomas: May be associated with PHACES syndrome — a rare condition involving brain, heart, and eye abnormalities — and need additional evaluation
  • Airway hemangiomas: A hemangioma near or inside the airway can make breathing difficult and needs urgent treatment
  • Ulcerated hemangiomas: When the surface breaks down (ulcerates), it causes pain, bleeding, and scarring risk
  • Liver hemangiomas: Can rarely cause serious complications

Treatment Options

Propranolol — First-Line Treatment

Propranolol, a beta-blocker medication, has revolutionized hemangioma treatment since its accidental discovery in 2008. It is the first-line treatment for hemangiomas that need intervention.

  • Typical dose: 2–3 mg/kg per day, given by mouth, divided into 2–3 doses
  • Treatment duration: usually 6–12 months
  • Results: over 90% of babies show significant improvement — the hemangioma lightens and shrinks
  • Color change is often visible within just a few days of starting treatment

Common side effects include disturbed sleep, decreased appetite, and loose stools — usually mild. Serious side effects are rare with proper monitoring. Your doctor will check your baby's heart rate and blood sugar when starting the medication.

Topical Timolol

A medicated eye drop (timolol) applied directly to the skin can help small, thin, superficial hemangiomas. It's a gentle option when systemic treatment isn't needed.

Laser Therapy

Pulsed dye laser can be used alongside propranolol to improve color and speed fading of the superficial layer.

Surgery

Surgery is reserved for hemangiomas that don't respond to medical treatment or cause severe problems. It is rarely the first choice.

When to See a Dermatologist

  • Your baby develops a red or bluish spot in the first weeks of life that is growing quickly
  • The hemangioma is on or near the eye, nose, lips, or ear
  • The hemangioma develops an open sore or wound (ulceration)
  • Your baby has a large hemangioma on the face or multiple hemangiomas on the skin
  • You notice the hemangioma is interfering with feeding, breathing, or vision
  • You have any concerns about a birthmark's growth or appearance

Frequently Asked Questions

Will the strawberry birthmark go away on its own?

Yes, in the vast majority of cases. About 90% of infantile hemangiomas completely resolve by age 9. The timeline varies — some disappear faster, some slower. Watching and waiting is appropriate for most hemangiomas that are not causing problems.

Should we treat it or wait and see?

This depends on where the hemangioma is located and whether it is causing or risking complications. Your dermatologist will weigh the expected course of the hemangioma against the risks and benefits of treatment. Many babies do best with careful monitoring; others genuinely need early treatment to prevent lasting problems.

Is propranolol safe for babies?

Yes, when used at appropriate doses with proper monitoring. Propranolol has been used widely in infants for decades for heart conditions. For hemangioma treatment, the doses are small and the safety record is excellent. Your child's care team will monitor carefully for any side effects.

Will the birthmark leave a scar or permanent mark?

Most hemangiomas — especially smaller ones — leave little to no mark after they shrink. Larger hemangiomas, especially those that ulcerate, may leave some pale or slightly textured skin. Treating complications like ulceration early reduces the risk of permanent scarring.

References

  1. Paller AS, Mancini AJ. Hurwitz Clinical Pediatric Dermatology. 5th ed. Elsevier; 2016.
  2. Leaute-Labreze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358(24):2649-2651.
  3. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. Elsevier; 2016.
  4. Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in children. N Engl J Med. 1999;341(3):173-181.
  5. Chen TS, Eichenfield LF, Friedlander SF. Infantile hemangiomas: an update on pathogenesis and therapy. Pediatrics. 2013;131(1):99-108.
  6. Suh KY, Frieden IJ, Drolet BA, et al. Infantile hemangiomas with PHACE syndrome. Arch Dermatol. 2001;137(12):1607-1612.

Trusted Resources

Always consult a board-certified dermatologist for an evaluation of your infant's hemangioma and to discuss whether monitoring or treatment is right for your child.