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Health condition · Clinically reviewed

Haemangioma, the childhood vascular tumour that usually resolves - and the ones that need treating.

Most infantile haemangiomas fade on their own. The job of the clinical team is to spot the ones that will not, and to act early with propranolol, laser or surgery.

Jump to treatment
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BAD, RCPCH and international consensus statements you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK vascular-anomaly practice including propranolol as first-line for problematic infantile haemangioma.

Key facts

Haemangioma at a glance.

The essentials in plain English: the main types, the natural history, and how UK teams treat problematic lesions in 2026.

  • What it is

    A benign vascular tumour of endothelial cells, most often appearing in the first weeks of life as infantile haemangioma.

  • How common

    Infantile haemangioma affects up to 5 to 10 per cent of infants, more often girls, preterm and low-birth-weight babies.

  • Natural history

    Classic infantile lesions proliferate for 3 to 6 months, plateau, then slowly involute over 5 to 10 years.

  • Types

    Infantile (superficial, deep, mixed), congenital (RICH, NICH, PICH), oral or mucosal, visceral and syndromic (PHACE, LUMBAR).

  • First-line therapy

    Oral propranolol is the international first-line treatment for problematic infantile haemangioma, under specialist care.

  • When to worry

    Airway, periorbital, ulcerating, large facial segmental and lumbosacral lesions all need early specialist review.

Why this guide matters

Watchful, not passive.

Haemangioma care is a mix of reassurance and early action. The three points below shape everything else on this page.

  • Most lesions involute

    Classic infantile haemangiomas grow for months, then slowly regress over years - many do not need active treatment.

  • Some lesions cannot wait

    Airway, periorbital, ulcerating and large facial segmental lesions can damage function and need early systemic treatment.

  • Propranolol changed the field

    Since 2008, oral propranolol has become the international first-line therapy for problematic infantile haemangioma.

How the diagnosis is made

From first mark to a clear plan.

The steps a UK GP, paediatrician or dermatologist will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Clinical history and timing

    Age at first appearance, growth pattern, prematurity and birth history all help distinguish infantile from congenital lesions.

  2. 02

    Assessing

    Examination and photodocumentation

    Location, size, depth (superficial, deep, mixed) and whether the lesion is focal or segmental, with serial photos to track growth.

  3. 03

    Assessing

    Risk-site assessment

    Periorbital, airway (beard distribution), nasal tip, lip, perineum and lumbosacral lesions carry higher functional risk.

  4. 04

    Confirming

    Ultrasound

    A quick, radiation-free way to confirm a vascular lesion and assess depth when the diagnosis is not clear on inspection.

  5. 05

    Confirming

    MRI or MRA (specialist commissioned)

    For deep, segmental, syndromic or visceral disease, and PHACE workup, MRI gives the definitive map of the lesion and its neighbours.

  6. 06

    Preparing

    Echocardiogram when indicated

    Considered for large hepatic haemangioma, multifocal disease and PHACE syndrome to look for high-output cardiac failure and arch anomalies.

  7. 07

    Preparing

    Vascular anomaly MDT

    Complex, syndromic or refractory cases are referred to specialist commissioned vascular anomaly clinics such as Great Ormond Street and Birmingham Children.

Typical timeline: weeks from first review to a settled specialist plan.

Symptoms

What a haemangioma looks like.

The classic superficial, deep and mixed forms, the complications parents notice, and the features that mean it is time to escalate.

  • Superficial (strawberry) lesion

    A bright red, slightly raised plaque or nodule, most obvious during the proliferative phase in the first 6 months.

  • Deep lesion

    A bluish, warm swelling with normal or blue-tinged overlying skin, easy to miss in the first weeks of life.

  • Mixed superficial and deep

    A red surface component sitting on top of a deeper bluish mass, common on the face and scalp.

  • Ulceration

    A painful, weeping breakdown of the surface, most often on lip, nappy area and neck folds, needing prompt treatment.

  • Residual skin changes

    After involution, some children are left with telangiectasia, fibrofatty tissue or loose skin that may need laser or surgery.

  • Segmental facial pattern

    A broad, plaque-like distribution over a facial segment can be a marker for PHACE syndrome and needs urgent workup.

  • Congenital lesion at birth

    A fully formed lesion present at birth suggests RICH, NICH or PICH rather than an infantile haemangioma.

  • Red flag - airway or eye involvement

    Noisy breathing with a beard-distribution lesion, or a periorbital lesion pressing on the eye, needs same-day specialist care.

Treatment

How haemangioma is treated in the UK.

Active observation for most, topical timolol for thin superficial lesions, oral propranolol as first-line for problematic disease, and laser or surgery for selected cases.

  • Active observation

    Small, uncomplicated lesions away from risk sites are watched with regular photos, since most involute without treatment.

  • Topical timolol 0.5 per cent

    A beta-blocker gel used for thin, superficial infantile haemangioma, typically applied twice daily under specialist guidance.

  • Oral propranolol

    International first-line therapy for problematic infantile haemangioma, given for 6 to 12 months with cardiac and glucose monitoring.

  • Oral prednisolone

    A historical option, now second-line, used when propranolol is contraindicated or not tolerated.

  • Pulsed-dye laser (PDL)

    Helpful for ulcerated lesions and for residual telangiectasia after involution, delivered by a specialist laser team.

  • Surgical excision

    Reserved for focal, refractory or residual lesions with fibrofatty tissue, planned by specialist paediatric plastic surgery.

  • Ulceration care

    Barrier dressings, gentle cleansing, topical or oral antibiotics for infection, and good analgesia while healing.

  • Vascular anomaly MDT

    A specialist commissioned team of paediatric dermatology, interventional radiology and plastic surgery coordinates complex care.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and international consensus standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your paediatrician or dermatologist knows your child and can tell you which parts apply. If in doubt, get seen.

  • NICE Clinical Knowledge Summaries. Haemangioma (strawberry naevus).

  • British Association of Dermatologists (BAD). Patient information leaflet on infantile haemangioma.

  • International consensus statement. Diagnosis and management of infantile haemangioma (Pediatrics).

  • Royal College of Paediatrics and Child Health (RCPCH). Guidance on propranolol for infantile haemangioma.

  • NHS England. Specialist commissioned service for complex vascular anomalies in children.

Red flags

When a haemangioma needs urgent attention.

Most lesions can be watched. These are the situations that cannot, and where a specialist opinion is needed quickly.

  • Airway obstruction

    Noisy breathing, stridor or a beard-distribution facial lesion can signal subglottic haemangioma and needs same-day ENT and paediatric review.

  • Periorbital lesion

    Any lesion pressing on the eye risks amblyopia and needs urgent ophthalmology and paediatric dermatology assessment.

  • Ulceration and bleeding

    A weeping or bleeding lesion is painful, prone to infection and can scar - it needs prompt specialist wound and pain management.

  • Large segmental facial lesion

    Raises the possibility of PHACE syndrome and needs MRI or MRA, echocardiogram and eye review under specialist commissioned care.

  • Lumbosacral or perineal lesion

    Can be linked to spinal dysraphism and tethered cord (LUMBAR); MRI of the spine and specialist commissioned review are indicated.

  • Multiple cutaneous lesions

    Five or more skin lesions raise suspicion of hepatic and visceral disease and warrant liver ultrasound.

  • Large hepatic haemangioma

    Can drive high-output cardiac failure, hypothyroidism and abdominal compartment problems, needing paediatric hepatology and cardiology input.

  • Rapid growth in a risk site

    Fast proliferation on the lip, nasal tip, ear or nappy area is an indication for early systemic treatment, not watchful waiting.

  • Psychosocial impact

    Disfiguring lesions carry a real psychological burden for children and parents and deserve early support and, where appropriate, treatment.

Living with it

A benign lesion, with a clear plan.

Four things that make the biggest difference for families day to day: photo tracking, gentle skin care, community support and staying in follow-up.

A quiet reminder

Involution takes years, not weeks.

Even a lesion that is clearly regressing can look worrying for a long time. Photos taken monthly show the real trajectory.

  1. 01 Photos

    Track growth with monthly photos

    Same background, same lighting, ideally with a ruler in shot, so the whole team can see the trajectory.

  2. 02 Skin

    Gentle skin care

    Bland emollients, sun protection and prompt attention to any breakdown help keep the surface intact.

  3. 03 Support

    Peer and family support

    The Birthmark Support Group and specialist nurses offer practical advice and community for families in the UK.

  4. 04 Follow-up

    Stay in the follow-up loop

    Even involuting lesions may leave changes that benefit from laser or surgery later - keep the specialist appointments.

Frequently asked

Everything we get asked about haemangioma.

Quick answers on types, natural history, propranolol and when treatment is needed.

  • What is a haemangioma?

    A haemangioma is a benign tumour made up of vascular endothelial cells. Most are infantile haemangiomas that appear in the first few weeks of life, grow rapidly for 3 to 6 months and then slowly involute over 5 to 10 years. Others are congenital, oral, mucosal or visceral.

  • How is an infantile haemangioma different from a congenital one?

    Infantile haemangioma usually appears after birth, grows quickly in the first 3 to 6 months and involves the marker GLUT-1. Congenital lesions (RICH, NICH and PICH) are fully formed at birth: RICH regresses over 12 to 14 months, NICH persists, and PICH partially involutes.

  • When does an infantile haemangioma need treatment?

    Treatment is considered when the lesion threatens function or appearance: airway, periorbital, ulcerating, large facial segmental, nasal tip, lip, perineum or lumbosacral lesions, and any lesion likely to leave significant disfigurement.

  • How does oral propranolol work?

    Propranolol is a non-selective beta-blocker that shrinks infantile haemangioma by reducing blood vessel growth signals and inducing regression. It is the international first-line therapy under specialist supervision, with baseline heart and glucose checks and typical treatment for 6 to 12 months.

  • What is PHACE syndrome?

    PHACE is an association of large segmental facial haemangioma with Posterior fossa brain anomalies, Arterial anomalies, Cardiac defects and coarctation, and Eye abnormalities. Any child with a large segmental facial lesion needs MRI or MRA, echocardiogram and eye assessment through specialist commissioned services.

  • Will the lesion leave a mark once it has gone?

    Many infantile haemangiomas involute with little residual change, but some leave telangiectasia, fibrofatty tissue, loose skin or scarring from ulceration. Pulsed-dye laser and, in selected cases, surgical excision can improve residual changes after involution.

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