Diana Kelly Levey

Congenital Hemangiomas and Vascular Malformations

February 8, 2018 | Categories:

Richard J. Antaya, M.D., Professor of Dermatology, Pediatrics and Nursing; Director, Pediatric Dermatology; Medical Director, Yale Dermatology Associates, explains what congenital hemangiomas of the skin are, different vascular malformations that occur in infants, what to be aware of if your baby either of these, as well as how to treat them.

A congenital hemangioma (hem-an-gee-o-ma) is a vascular lesion that is present and fully grown at birth. Doctors may diagnose a congenital hemangioma on a prenatal ultrasound.

How is a congenital hemangioma different from an infantile hemangioma?

Congenital hemangiomas are essentially like infantile hemangiomas except they have the growth phase when the baby is in utero. An infantile hemangioma starts growing and the growth pattern is always postnatal. The congenital hemangiomas are there at birth. They do not grow after the baby is born.

What are the different types of congenital hemangiomas?

Congenital hemangiomas are divided into two major subtypes based on clinical behavior: rapidly-involuting congenital hemangioma (RICH) and non-involuting congenital hemangioma (NICH). There is also partially-involuting congenital Hemangioma (PICH), which shrink a little but then never really go away completely. RICH look a lot like sort of a purplish nodule and go away very quickly, they start shrinking within the first few months of life and are usually gone within the first year. NICH never shrink or go away. They look almost like a venous malformation and tend to be very stagnant. Usually parents will bring the patient to a specialist after the baby is a few months old, because they suspected it to be infantile hemangioma but it didn’t go away. Once a doctor has diagnosed it as a NICH, and a lot of time those are treated with surgery and removed if the patients want them removed.

What is a vascular malformation?

Like congenital hemangiomas, these are also growths of blood vessels and are often present at birth. They’re also called birthmarks. But they may not be seen for months or weeks after birth. They grow slowly throughout life and don’t shrink like RICH and infantile hemangiomas do. The five types are: port wine stains (red or purple in color), venous malformations (darker blue and soft), lymphatic malformations (made of the lymph vessels), arteriovenous malformations (associated with big veins), or mixed malformations which can be a combination of any of the other types. If it’s not present at birth, and or it increases or decreases in size, it’s called a vascular neoplasm.

What are the biggest concerns with these skin malformations?

While these aren’t harmful to a baby or child, most parents are concerned about disfigurement, especially if the malformation is on the head or neck area.

What causes these?

Doctors and scientists aren’t sure of what causes hemangiomas and vascular malformations in infants and have just started studying them in the past 20 or so years. They don’t have anything to do with what the baby’s mother ate or drank (or didn’t consume) during pregnancy. They may be more likely to be passed down in some families through autosomal dominant inheritance. This means one parent needs to have the gene to pass it on. If the parent has the gene, the family has a 1 in 2 chance that each child will have this condition.

How are these issues treated?

If the infant has any type of a vascular lesion on the face, it’s a good idea for the parent to bring them to a specialist as early as possible. If it is infantile hemangioma, some of them can be incredibly devastating once they start growing. [LINK TO OTHER ARTICLE?] The right physician can institute treatment and stop the growth by intervening. Prevention is critical for these lesions. For vascular malformations, there is some data that suggests that treating infants is more effective then waiting until they are older. Doctors at Yale Medicine will treat infants as early as two to three weeks of age with a laser to get rid of port wine stains. The laser damages the vessels under the skin and helps make the signs on the surface go away. Oftentimes, doctors at Yale Medicine will also apply medicine called Sirolimus topically to the area after laser treatment to prevent the regrowth of the blood vessels. If a child has an arterial malformation or venous malformations, their doctor might administer injections. Sometimes patients might receive a combination of laser therapy, injections, and/or topical medications.

How is Yale Medicine’s approach to treating congenital hemangiomas and vascular malformations in babies unique?

The scientists and physicians at Yale’s internationally-recognized Vascular Malformation Clinical and Research Group have been are studying malformations for over 20 years, particularly hemangiomas. “We have done research with hemangiomas, we’ve also done some research with parents and education over the years and I think it shows,” says Dr. Antaya. The specialists at Yale Medicine also work very well with the referring doctors, keeping them informed with what’s going on and working with them to track how the patient is doing after treatments. “If there are new [treatment options] out there, we are looking at them and try to improve patient care essentially,” says Dr. Antaya.

This article was originally written for Yale’s School of Medicine website.

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