haemangiomas

Haemangiomas are benign vascular tumors characterized by abnormal proliferation of blood vessels. They are most frequently diagnosed in infants and children, although adult cases do occur. Infantile haemangiomas, the most common subtype, typically appear within the first few weeks of life, reach a peak size between 4 and 12 weeks, and then usually regress spontaneously over several years.

There are several histologic variants. Capillary (or strawberry) haemangiomas present as superficial red lesions; cavernous haemangiomas are deeper, displaying large dilated vessels; arteriovenous haemangiomas result from abnormal connections between arteries and veins; and mixed lesions contain features of more than one type. The lesion distribution and depth influence clinical appearance and management.

The exact cause is unclear, but genetic mutations in the TEK gene (encoding the endothelial cell tyrosine kinase TIE2) and disruptions of angiogenic pathways have been implicated. Hormonal factors, low birth weight, and prematurity are recognized risk factors. Female infants are slightly more commonly affected.

Clinically, harmless lesions may be observed, whereas rapidly enlarging, painful, or functionally impairing haemangiomas warrant intervention. Excisional biopsy is rarely needed; diagnosis is usually clinical, supported by ultrasound, MRI, or Doppler studies in ambiguous cases.

Management strategies differ by lesion type and severity. Many infantile haemangiomas resolve without treatment. Pharmacologic therapy, particularly oral propranolol, has become the first-line treatment for problematic lesions, reducing size and color. Corticosteroids, interferon, and sirolimus are alternatives for refractory cases. Surgical excision, laser therapy (pulsed dye laser), and sclerotherapy are reserved for lesions that threaten function, vision, or wound healing.

Prognosis is generally favorable. Approximately 70–80 % of infantile haemangiomas involute completely by adulthood. Residual skin changes or cosmetic concerns may persist. In rarer cases, haemangiomas can cause systemic complications such as high-output cardiac failure, ulceration, or bleeding. Early recognition and a multidisciplinary approach enable optimal outcomes.