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Infantile hemangioma and vascular malformations
Vascular anomalies are divided into tumours, which grow and then regress — mainly infantile hemangioma — and malformations, which are present from birth, grow with the child and do not regress; propranolol is the treatment for a high-risk hemangioma.
Why it matters in the exam
The exam shows a one-month-old baby with a bright red "strawberry" lesion that appeared after birth and is growing quickly, and asks when to treat: periocular hemangioma (threat to vision), on the nose and lip (disfigurement), in the "beard" area (risk of airway hemangioma), ulcerated hemangioma, or multiple hemangiomas (liver work-up). Also asked are PHACE (a large segmental facial hemangioma with brain, vascular and cardiac anomalies), LUMBAR (a lumbosacral hemangioma with spinal anomalies), propranolol treatment at 1–3 mg/kg/day with feeds to prevent hypoglycaemia, and the Kasabach-Merritt phenomenon — which does not occur in an ordinary hemangioma but in other tumours. Remember that most growth occurs by 5 months of age, so the treatment window is early; referral to a dermatologist should happen by one month of age when there are risk signs. The key understanding is that a vascular malformation will not disappear with time.
Key points
- Vascular anomalies are divided into tumours that grow and regress and malformations that are present from birth and do not regress.
- Infantile hemangioma appears in the first weeks, grows mainly until 5 months and regresses slowly; it is GLUT1 positive.
- Propranolol at 1–3 mg/kg/day is the treatment for a high-risk hemangioma and must be given with feeds.
- A large segmental facial hemangioma requires a PHACE work-up, and multiple hemangiomas require a liver check.
- A port-wine stain is a capillary malformation that does not regress, and in the V1 area it may be part of Sturge-Weber.
Summary table
| Anomaly | Course | Features | Treatment |
|---|---|---|---|
| Infantile hemangioma | Appears in the first weeks, grows until 5 months, regresses slowly over years | GLUT1 positive; superficial red or deep bluish | Observation; propranolol 1–3 mg/kg/day for a high-risk hemangioma; topical timolol for small superficial lesions |
| Congenital hemangioma (RICH, NICH) | Fully formed at birth | GLUT1 negative | RICH regresses in the first year; NICH does not regress |
| Kaposiform hemangioendothelioma | Firm, expanding purple mass | Kasabach-Merritt phenomenon: severe thrombocytopenia and factor consumption | Sirolimus, vincristine |
| Port-wine stain (capillary malformation) | Present from birth, grows with the child, thickens in adulthood | In the V1 area — Sturge-Weber | Pulsed dye laser, early |
| Venous and lymphatic malformation | Present from birth, swells with straining or infection | Venous: bluish, compressible; lymphatic: cysts | Sclerotherapy, sirolimus, surgery |
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Sources
- AAP clinical practice guideline for the management of infantile hemangiomas, 2019 — Risk stratification and propranolol
- ISSVA classification for vascular anomalies, 2018 — Tumours versus malformations
- European expert consensus on propranolol for infantile haemangioma, 2015 — Dosing and monitoring
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.