anyone know about strawberry hemangiomas?

dawngloves, BSN, RN · Nov 10, 2003

Some things you just don't learn about until you take the initiative. Makes you smarter and a better nurse.

My 36 weeker daughter had a hemangioma on her shoulder that presented two days after she was born. I all but accused the nurses of injuring her!:imbar

These are common amungst the preemie set, but still atypical, about 2 percent of all neonates.

Strawberry hemangiomas can continue to grow for about a year and then fade. My daughters was gone by the time she was 3.

They are highly vascular and susceptible to trauma, say diaper rash. It can ulcerate and cause bleeding. IMHO if it continued to bleed and cause pain, I would see a pediatric plastic surgeon.

HTH!

NICU_Nurse, BSN, RN · Nov 10, 2003

http://www.hnline.org/index.htm

Hemangiomas

Approximately thirty percent of all Hemangiomas are visible at birth. The remaining seventy percent become visible within one to four weeks after birth. Hemangiomas are five times more prevalent on females and occur predominantly in Caucasians. Premature and infants weighing less than I kilo or 2.2 pounds are three times more susceptible to this condition. While these statistics are interesting, there is no known cause for Hemangiomas.

Hemangiomas occur on the head and neck seventy to eighty percent of the time. Approximately twenty percent appear throughout the rest of the body. They can occur internally and externally. Hemangiomas vary in size and shape. Some are very small and present no medical or cosmetic concerns, while others are large, disfiguring and present medical and psychological concerns.

When hemangiomas first appear, they are often small and can be either blue or red in color. They may be raised or flat. Most hemangiomas grow during the first few weeks; they are rarely full grown at birth. "Superficial" hemangiomas are flat and red. Those that are deep beneath the skin and appear blue in color are called "Deep" hemangiomas. Hemangiomas often have both superficial and deep components; they are called "Compound Hemangiomas". Hemangiomas will typically grow for nine to twelve months; some may grow up to about eighteen months. After completing the growth phase, a hemangioma will plateau and then enter into a spontaneous regression period. This is called involution. While all Hemangiomas eventually involute, the result is not always cosmetically acceptable. Many physicians have reported that early intervention will reduce the need for corrective plastic surgery at a later age. When early intervention is denied the lesions may grow large and cause permanent tissue damage.

The psychological implications of facial deformity cannot be ignored. Parents should consider that children become socially interactive between two and three years of age. Early intervention by an experienced physician, can minimize the disfigurement.

In rare cases, hemangiomas can cause life-threatening complications. Usually these lesions are large, greater the twenty-five sq. centimeters of surface area. These lesions may cause disorders related to eating, breathing, vision, hearing and speech. Large hemangioma-like lesions called hemangioma-endothelioma kaposi are also associated with complications leading to clotting abnormalities or congestive heart failure. Although these lesions are not actually true hemangiomas, they are often first diagnosed as such. Infants with four or more hemangiomas of the skin are at risk for internal hemangiomas on the liver, airway, brain or digestive track. Internal hemangiomas or visceral lesions are often difficult to detect. Infants with internal hemangiomas may show signs of jaundice, blood in the stool, croupy cough or difficulty in breathing (stridor). Ultrasounds or MRIs may be performed to rule out internal hemangiomas in children with multiple skin lesions.

Interesting pictures of large hemangioma before and after alpha-interferon tx:

Before:

After:

And specifically related to your situation, an article about diaper-area hemangiomas (and tx, if they're painful, etc.:)

I'll post this (edited a bit by me), but here's the link:

http://members.tripod.com/~Michelle_G/diaper.html

Karla Hall, Medical Research

Executive Director, Hemangioma Newsline

One of the most complicated areas a hemangioma can develop in is the urogenital area or anogenital area. These lesions commonly called diaper area hemangiomas are associated with pain, bleeding, recurring infection and ulceration.

Traditional treatments included wound care, cold compresses of Burrows solution, antibiotic ointments and zinc oxide base creams. These treatments provide simple lesions with some protection from urine and feces but provide little or no improvement for the ulcerated urogenital or anogenital lesion. Current research shows that the aggressive use of pulsed dye laser can selectively cause a thermal reaction in the vasculature resulting in photocoagulation and rapid resolution of the ulcerated lesion. There have also been reports of similar results using the Argon laser. However this laser is controversial because of the increased potential for scarring.

The most common complication of superficial hemangioma is ulceration. Ulceration of hemangiomas occurs in up to 10% of all lesions during the growth period. As the hemangioma grows the skin can not keep up. The elasticity of the skin is reduced, it then splits and opens. This causes ulceration. Because the skin over a hemangioma is compromised it is not unusual for it to split after just a slight bump. Since the hemangioma is growing faster then the skin, the skin can not repair itself, healing may not occur for months.

Ulcerated hemangiomas are a great risk for infection. Perianal and urogenital lesions are at an increased risk for infection because of urine and feces. Even the most careful diapering can't prevent infection. Once ulcerated all hemangiomas become painful. In the presence of a wet or soiled diaper this pain can be exasperating. Cleaning the area becomes more difficult and thus the risk of infection becomes greater. Some babies can't be bathed, water alone causes severe pain. Untreated ulceration that becomes infected can lead to more serious cellulitus. Standard barrier methods of protection become ineffective and can irritate the child more. Using a semipermeable dressing over the wound and changing it frequently may ease pain. (Vigilon is one product used. )

In addition to the pain and the risk of infection associated with ulcerated "diaper" area hemangioma, all ulcerated hemangioma leaves residual scarring. Although in the diaper area the cosmetic concerns are not as critical, the destruction of normal sensitive nerve tissue as a result of scar tissue accumulation can not be ignored.

The treatment of diaper area hemangioma becomes essential to reduce the pain and risk of infection to the child. Standard treatments include, observation, steroid, laser, surgical excision and in extreme cases interferon. Since most diaper area hemangiomas are associated with ulceration, pain, bleeding and infection observation should be excluded. Early intervention of diaper area hemangioma may prevent any of the complications from occurring. Aggressive Laser treatment of the area is documented to be the most effective tool in the management of diaper area hemangiomas. Lasering the ulcerated area can improve the patients discomfort however this is related to the depth of the ulceration. The deeper the ulceration the grater the tendency towards pain and the longer the healing period.

Proliferating hemangiomas respond well to oral steroid treatment. The Prednisone class of drugs is used to slow the growth of proliferating hemangiomas. Brand names include, prelone, and deltasone. Corticosteroids are natural hormones produced by the adrenal glands. They have potent anti-inflammatory properties. Recent studies confirm that 30% of patients respond to doses of Prednisone of 2-3mg/kg-body weight. However steroid treatment is only useful during the proliferative phase in most cases. Oral steroids do have side effects that frighten most parents. The side effects of oral steroid use include gastric reflux, and stomach irritation. These symptoms can be eliminated with the use of prescription Zantac or Propulsid. Increased irritability, increased susceptibility to infection, and impairment of the natural immune response to infection are other complications of steroid use. These effects can result in a delay of normal vaccines for infants. Children may become "cushnoid" in that they can become "chubby" and appear round in the face. In rare cases they may have a growth in body hair. Treatment must continue during the growth of the lesion or until the 7-8 month of age when growth naturally slows.

Some physicians prefer interlesional injection of steroid to the oral use. This technique works well in localized and small lesions. Recent reports show no advantage of injection over oral use. Injection in the diaper area is not the treatment of choice. Injections are extremely painful and require sedation. Injection does not reduce the side effects.

A second pharmacological treatment of hemangioma is interferon. Alpha 2a interferon is an antiviral drug developed in the research of cancer treatments. It was discovered that it had antiangiogenic application. (Ability to shrink blood vessel tumors) This drug was promising until it was shown that infants on interferon experience a delay in motor development and in severe cases spastic dysplasia. These neurological complications are cause for concern. Many physicians are not using the drug in infants. Some are still cautiously using the drug only if steroid treatment fails. Other antiageigenic agents are being evaluated for use in the treatment of complicated or endangering hemangioma. If life threatening conditions such as congestive heart failure, airway obstruction, visual obstruction, thrombocytopenia( Kasabach Merritt syndrome) exist it would be prudent to contact one of the major treating facilities for treatment protocols.

Interferon is not usually a treatment for diaper area lesion. Surgical excision of the urogenital hemangioma or analgenital hemangioma is difficult because of the sensitive organ structures involved. If surgical excision is recommended be sure to determine why the other treatment options have been rule out first. General surgeons with limited experience in the treatment of vascular lesions should be avoided. Many have recommended extreme surgeries for superficial lesions. Research any surgeon before considering excision of diaper area lesions. Ask to speak to other patients with similar lesions.

Children with diaper area hemangiomas are in pain. Even the smallest lesion can ulcerate if it is near the rectum. The ulceration will continue to tear with each bowel movement. These lesions can grow into the lady parts or rectum. They can obstruct urinary flow, or normal bowel movement. Untreated an older toddler may hold his daily bowel movements for fear of the pain and this can result in severe constipation and further digestive complications. Early intervention with aggressive laser proves to be the best tool available for the treatment of this type of lesion. The statistics reported in the literature support early intervention and the clinic reports support aggressive application for maximum results and complete resolution.

Homeopathic suggestions to ease the pain of ulcerated hemangioma:

Ulcerated Hemangiomas are always associated with pain. Over the years, when medical treatment was not available mothers and physicians developed ways to ease the pain. Here is a list of methods that may help ease the pain until proper treatment by an experienced physician is received. Some of these methods are also used following laser surgery. Zinc Oxide creams provide a barrier to urine and feces as well as keep the area moist. Some physicians express concern for infection while using these products. Stay away from fragrances; Desitin seems to be a good choice as well as generic zinc oxide cream. AquaPhor ointment is another excellent barrier against urine and feces. It is like petroleum jelly except is water-soluble so it will was away without wiping. Several doctors advise using it after laser surgery also. Second Skin burn pads draw the heat away from the skin into a moist gel pad, which does not stick to the skin. It can be used after laser to draw the heat away. Bathing is a concern for ulcerated hemangioma. Sea Salt Baths seem to soothe the child while normal water baths can cause pain. Salt-water baths should be very dilute, like contact saline without the preservatives. Sea Salt can be purchased at health food stores read the directions for dilution. Air drying the area where possible is best, never wipe with a towel to dry. Squirt bottles filled with water or saline solution instead of wipes or wet cloths to clean the area is best. It is better to leave a small amount of soil behind and get it in the bath later then to wipe the skin. Be careful not to overuse topical antibiotic creams without consulting your doctor, these can cause irritation and make things worse.

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Bold areas are highlighted in case you don't want to read the entire article. Hope this helps! I learned something new.

zambezi, BSN, RN · Nov 10, 2003

A friends daughter had a strawberry hemanginoma on her face, top of her nose, near her eye...it also appeared a day or two after birth. She is one now and it is still there though has shrunk slightly...

RNonsense · Nov 10, 2003

My son developed one when he was a month old, quite large and on his outer leg. My pediatricain was wonderful and said essentially everything that is mentioned above. His did fade after a time and was completely gone by the time he was four.

sherrifw · Jan 29, 2004

My hemangioma appeared a couple of days after birth, on my right shoulder. The doctors said it would go away about 5 years of age. I dont think so. Im 19 and to this day its still as big as it ever was. They call it a capulary hemangioma. (strawberry).. They said if I were to have it removes, i would have someone of a huge dent in my arm, since only blood and capularies are underneath it. So ive yet to explore that option.

gypsyatheart · Jan 29, 2004

WOW! NICU Nurse...What a great post...thanks for the material, I definitely learned a lot from this!:)

wiz2629 · May 29, 2004

Hello, I am looking for anyone with information on transitory hemangiomas. I know that isn't a term most are familiar with, as far as I know I have the only diagnosis. I was born with vascular deformities of my left leg and had a battery of tests for years at Stanford Hospital before I was finally given the diagnosis of my own syndrome. I have hemangiomas that grow and heal spontaniously. Along with the hemangiomas, I have complications due to the hemangiomas and am now in a wheelchair. I would love to know if I am the only one out there with this. Any help would be greatly appreciated and please feel free to email me. Thanks.

nic1073 · Mar 29, 2009

My daughter developed a stawberry hemangioma when she was approximately 2 weeks old. It developed on her right labia. Shortly afterward the hemangioma ulcerated. She was in excruciating pain. I tried ointments, laser therapy, steroid treatment, ect. but nothing worked. I finally started thinking like a nurse and stopped relying on the doctors recommendations. I began using 3M Tegaderm cut to size to cover the area and protect it from urine and stool. It took about 4-6 weeks to completely heal. I am happy to say that she is now 9 months old and even though her hemangioma is still there and has not decreased in size, it has not reopened. I continue to use the Tegaderm on a daily basis to protect the delicate skin.

charli2010 · Aug 26, 2011

Hi everyone, fab information given! My son has two of these strawberry hemangiomas one on the back of his neck and one just under his right eye the one under his eye burst yesterday 4 times it soon clotted however everytime he rubs his eyes it pops again is there anything i need to worry about or do? I did take to him his GP but they were not very helpful cleaned him up and sent us away. :confused:

babyNP., APRN · Aug 27, 2011

Hi there,

We cannot give advice on this forum as it's not appropriate legally or ethically. If you feel as though your GP is not listening to your concerns, by all means ask to see another one. Best of luck.

prmenrs, RN · Aug 27, 2011

Reminder: We cannot provide medical advice. Please continue to request information from your health care provider. You are probably entitled to a second opinion.