Haemangioma (strawberry mark): what it is, how long it lasts and how it is treated

An infantile haemangioma is a birthmark made up of a collection of small blood vessels. Many families know it as a strawberry mark or strawberry naevus. Hospital information for parents from Newcastle Hospitals says it appears shortly after birth, grows over the first few months of life and then gradually shrinks over time.

NICE says haemangiomas near the surface of the skin are usually raised, bright red areas, deep haemangiomas may appear blue, and mixed haemangiomas grow near the surface and deeper under the skin. The NHS adds that a strawberry mark can sometimes appear under the skin, making it look blue or purple.

The name can be confusing because strawberry marks are only one type of birthmark. The NHS describes several others, set out in the comparison below.

Telling birthmarks apart matters because they behave differently. Some fade on their own within months, some last for life and a few are linked to other conditions. The table uses the descriptions on the NHS birthmarks page.

NICE says strawberry marks are caused by abnormal blood vessels growing in the skin or deep under the skin, or a combination of both. The sources reviewed for this guide do not explain why those vessels form, and nothing a parent does in pregnancy or after birth is described as causing them.

The NHS lists the babies in whom they are more common: girls, babies born before 37 weeks, babies with a low birthweight and multiple births such as twins. They are not described as infectious or something a baby can catch.

Haemangiomas follow a recognisable pattern of fast growth followed by slow shrinkage. NICE says they often grow quickly in the first 3 months of life and sometimes become redder, and that it is unusual for them to grow after 6 to 10 months. At that age most stay the same size for a while and then begin to shrink.

The NHS gives the longer-term picture: strawberry marks get bigger for the first 6 to 12 months and then shrink and disappear by the age of 7. How much trace is left varies from child to child, and a GP or paediatric dermatology team can explain what to expect for a particular mark.

• First weeks: the mark appears, often at 4 to 6 weeks of age (NICE).

• First 3 months: growth is often fastest (NICE).

• 6 to 12 months: growth slows and stops (NHS, NICE).

• Years afterwards: the mark shrinks; the NHS says it has gone by age 7.

NICE says most infantile haemangiomas do not need treatment, but they need to be looked after carefully because they can bleed if scratched. Newcastle Hospitals says treatment is considered when a mark causes problems, for example if it is near the eye and may affect vision, or if it bleeds, becomes infected or becomes painful.

NICE lists the treatments that may be used: steroids taken by mouth, injected or applied as a cream; beta-blockers such as propranolol taken by mouth, or timolol applied as a solution or gel to the surface of the mark; laser treatment; and surgery. Emollient creams, dressings, pain relief and antibiotics may also be needed. NICE notes that some of these are used off-label.

The NHS describes the same three broad approaches for birthmarks: medicines to reduce blood flow and slow growth, laser therapy (which it says works best if started between 6 months and 1 year of age) and surgery, which can leave scarring. The NHS says a birthmark can be removed on the NHS if it is affecting a person's health.

Newcastle Hospitals describes propranolol as a beta-blocker given as a liquid that helps stop haemangiomas growing and can speed up shrinking. It says the medicine has been used for many years for heart conditions and high blood pressure, and that it is not suitable for children with certain health problems, such as asthma, which the doctor discusses before starting.

In its leaflet the first dose is given in hospital, with the child weighed, heart rate and blood pressure checked and then monitored for four hours. After that, doses are given at home twice a day, about 12 hours apart, with or straight after a feed or meal. Treatment normally continues during the growing phase, usually until about one year of age, and can be restarted if the mark begins to grow again after stopping.

Side effects listed include disturbed sleep, tummy ache, blue fingertips and cold hands or feet, wheeze and cough, and a slow heart rate. Rarely, propranolol can cause low blood sugar. Newcastle Hospitals advises feeding at least once every 5 hours for babies under 3 months and at least every 8 hours for older children, and says to give no dose if the child is not eating, is vomiting or is wheezy. Always follow the instructions from your own child's team, as leaflets vary between hospitals.

Most strawberry marks are harmless, but position and change matter. The NHS lists when to see a GP and says the GP may ask you to watch the birthmark for changes or refer you to a skin specialist (dermatologist).

• You are worried about a birthmark (NHS).

• The birthmark is close to the eye, nose or mouth (NHS).

• It has got bigger, darker or lumpier (NHS).

• It is sore or painful, or it bleeds or looks infected (NHS, Newcastle Hospitals).

• A child on propranolol seems irritable or restless, unusually tired, sweaty, shaky or has a big change in hunger: Newcastle Hospitals says to see a GP or the local emergency department immediately because these can be signs of low blood sugar.

On the NHS, the NHS page says a GP may ask you to watch the mark for changes or refer you to a skin specialist (dermatologist). In the Newcastle Hospitals leaflet, propranolol is started in hospital with monitoring. The NHS says a birthmark can be treated on the NHS when it is affecting health, but removal for cosmetic reasons has to be paid for privately.

Private paediatric dermatology exists for families who want quicker access or a second opinion. The medical approach is the same, so ask for a letter to your GP so your child's records stay in one place.