The Bottom Line

Infantile hemangiomas are the most common tumor found in babies — affecting about 4-5% of infants. They look alarming but are almost always harmless, and about 90% shrink on their own by age 9. When a hemangioma is in a risky location or growing fast, a medication called propranolol can shrink it by 60-90% in most cases. Early evaluation by a dermatologist helps make sure your baby gets the right care at the right time.

What Is an Infantile Hemangioma?

A hemangioma is a benign (non-cancerous) overgrowth of blood vessel cells in the skin. The word sounds scary, but think of it as the body's blood vessels temporarily "overbuilding" in one small area. Infantile hemangiomas are the most common tumor in babies, showing up in about 4-5% of children by age 5. Premature or low-birthweight infants are at higher risk — the rate climbs to 12-22% in those groups.

Most hemangiomas go through three predictable stages:

  • Proliferative phase (growth): Rapid growth from birth to about 6-12 months old.
  • Plateau phase: Growth slows and the hemangioma stabilizes.
  • Involution phase (shrinking): The hemangioma slowly fades and flattens, usually over 1-7 years.

Girls are affected 3-5 times more often than boys. About 25% of babies have more than one hemangioma. The majority — 60% — appear on the head or neck.

What Does a Hemangioma Look Like?

Hemangiomas come in two main forms:

  • Superficial hemangiomas: Bright red, raised, and spongy — often described as a strawberry birthmark. They sit close to the skin surface.
  • Deep hemangiomas: Bluish-purple or skin-colored bumps that form deeper under the skin. The overlying skin may look normal at first glance.

Some hemangiomas are a mix of both types. They may not be visible at birth — many appear within the first 2 weeks of life as a faint red patch, then grow quickly over the next few months. In some babies, a small bruise-like mark or pale patch at birth is actually an early hemangioma.

What Causes Hemangiomas?

Hemangiomas form when blood vessel cells (endothelial cells) multiply faster than normal in a localized area. The exact trigger isn't fully understood, but certain factors raise the risk: being born premature, having a low birth weight, and placental abnormalities are all linked to higher rates. Having a family history also plays a role. Hemangiomas are not caused by anything a parent did or didn't do during pregnancy.

When Should I Worry? Potential Complications

Most hemangiomas cause no problems and simply fade with time. However, some locations and sizes do carry risks:

  • Around the eye: Can block vision and cause permanent vision problems if not treated early.
  • On or near the airway: Even a small hemangioma near the voice box can cause breathing difficulty.
  • Large facial hemangiomas: May be associated with PHACES syndrome — a combination of brain, heart, eye, and skin abnormalities affecting 7-10% of children with large facial hemangiomas.
  • Ulceration: About 5-13% of hemangiomas break down and form sores, causing pain and raising infection risk.
  • Cosmetic impact: Hemangiomas on the face or other visible areas may leave residual scarring or skin texture changes after shrinking.

Treatment Options

Watchful waiting: For small hemangiomas in low-risk locations, observation alone is often the right choice. Your doctor will monitor the growth rate and intervene only if needed.

Propranolol (oral medication): This is now the standard first-line treatment for hemangiomas that need intervention. Propranolol is a beta-blocker originally used for heart conditions, but it turns out to be remarkably effective at stopping hemangioma growth and causing them to shrink. In most cases, it reduces the hemangioma's size by 60-90%. Treatment typically starts at a low dose — around 0.5-1 mg/kg per day — and is gradually increased to 2-3 mg/kg per day. Your baby's heart rate, blood pressure, and blood sugar will be monitored throughout. The most important precaution: never fast your baby for long periods while on propranolol, because it can cause low blood sugar.

Topical timolol: A topical beta-blocker gel applied directly to small, superficial hemangiomas. Less powerful than oral propranolol but useful for smaller lesions.

Corticosteroids: Sometimes used for severe or resistant cases in older children. Less commonly used since propranolol became available.

Laser therapy: Pulsed dye laser (585-595 nm) is used to treat residual redness and improve skin texture after a hemangioma has mostly involuted.

Surgery: Reserved for residual scarring or for lesions that haven't responded to other treatments, generally after age 4-5.

When to See a Dermatologist

  • Any hemangioma on or near the eye, nose, mouth, or airway — these need urgent evaluation.
  • A hemangioma that is growing rapidly in the first 3-6 months.
  • Any hemangioma that develops a sore or ulceration — especially painful and needs prompt treatment.
  • A large hemangioma on the face (may need imaging to rule out PHACES syndrome).
  • Multiple hemangiomas (5 or more) — internal organ involvement should be ruled out.
  • Any time you're unsure whether a mark on your baby's skin is a hemangioma.

Is propranolol safe for my baby?

Yes — propranolol has become the standard of care for infantile hemangiomas precisely because it is effective and well-tolerated. Your doctor will do baseline tests (heart rate, blood pressure, ECG, and often an echocardiogram) before starting. The main risks are low blood sugar — which is prevented by never skipping or delaying feeds — and rarely, slow heart rate or wheezing. Regular follow-up visits keep your baby safe throughout the treatment period, which typically lasts 6-12 months.

Will the hemangioma leave a permanent mark?

About 90% of hemangiomas shrink significantly on their own by age 9. However, 10-20% of children are left with residual changes — such as extra skin, slight discoloration, or textural differences. Starting propranolol early (during the proliferative phase) significantly reduces these residual effects by minimizing the total volume the hemangioma ever reaches.

Will other children develop hemangiomas?

Infantile hemangiomas are generally not strongly hereditary — having one child with a hemangioma does not dramatically increase the risk for future children. That said, premature birth and low birth weight are the strongest risk factors, so those considerations do apply to future pregnancies.

My baby has a hemangioma near her eye but it seems small. Can we wait?

Periocular (around the eye) hemangiomas are one situation where early treatment is strongly recommended, even if the hemangioma looks small. Vision develops rapidly in the first years of life, and even a moderately-sized hemangioma pressing on or near the eye can interfere with visual development in ways that become permanent. Don't wait — get an evaluation from a pediatric dermatologist or ophthalmologist promptly.

References

  1. Leaute-Labreze C, Harper JI, Hoeger PH. Infantile haemangioma. Lancet. 2017;390(10089):85-94.
  2. Drolet BA, Frommelt PC, Chamlin SL, et al. Initiation and use of propranolol for infantile hemangioma. Pediatrics. 2013;131(1):128-140.
  3. Frieden IJ, Haggstrom AN, Drolet BA, et al. Infantile hemangiomas: current knowledge, future directions. Pediatr Dermatol. 2005;22(5):383-406.
  4. Garzon MC, Epstein LG, Heyer GL, et al. PHACE syndrome: consensus-derived diagnosis and care recommendations. J Pediatr. 2016;178:24-33.

Trusted Resources

Always consult a board-certified dermatologist for diagnosis and treatment recommendations specific to your child's condition.