Are the red marks on the baby's body hemangiomas or vascular malformations?

Author: Shen Gang, Chief Physician, Children's Hospital, Capital Institute of Pediatrics

Reviewer: Liu Li, Chief Physician, Beijing Children's Hospital, Capital Medical University

Parents are often confused and concerned when they notice red patches on their baby’s skin. These patches may be a sign of a hemangioma or vascular malformation, both of which are related to the vascular system, but their nature, causes, and treatments are very different.

The key to distinguishing hemangiomas from vascular malformations is to understand their cell proliferation status. Hemangiomas are true tumors with cell proliferation, most of which are benign, but there is also the possibility of malignant transformation; while vascular malformations are mainly manifested by abnormal vascular structure without obvious cell proliferation activity.

Regarding the red patches on children that parents are concerned about, the following three points are the key basis for determining whether it is a hemangioma or a vascular malformation:

1. Time of onset: Hemangiomas usually appear within a few days after birth, rather than existing at birth; in contrast, vascular malformations are mostly visible at birth.

2. Growth rate: Hemangiomas grow faster in the early stages and usually increase significantly in size within a short period of time after birth; whereas, the growth rate of vascular malformations is relatively slow, especially within one year of an infant, and their size does not change much.

3. Color characteristics: Infantile hemangioma is the most common type of hemangioma, accounting for more than 95% of hemangiomas, and its color is bright red; while the color of vascular malformations is usually lighter, mostly pink or bluish purple, and is located deeper, beneath the skin.

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Furthermore, hemangiomas do not only grow on the surface of the skin. Although most (about 70%-80%) appear on the head, face and neck, a considerable number of them also occur on the limbs, and may even appear in internal organs such as the liver, spleen, intestines, throat, and deep tissues such as the eyes and nose.

For visceral hemangiomas that cannot be directly observed, if multiple hemangiomas appear on the body surface of an infant or young child at the same time, it is necessary to be alert to the possibility of such problems in internal organs such as the liver. Especially when the liver hemangioma grows rapidly, it may have a serious impact on body function and even cause symptoms of heart failure.

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The incidence of hemangioma in infants and young children is relatively high, about 2%-5%. It is more common in girls, premature infants, and low-birth-weight infants. For example, twins sometimes suffer from the disease at the same time.

The causes and heredity of hemangiomas are still not completely clear. Among the many theories, genetic theory and environmental factors have attracted much attention. Genetic variation is considered to be an important factor affecting the occurrence of infantile hemangiomas, but which specific gene causes hemangiomas still needs further study. In addition, environmental factors such as diet may also be related to the occurrence of hemangiomas, but these factors have not been supported by definitive evidence.

As for whether hemangiomas are hereditary, there is currently no clear evidence that hemangiomas are hereditary. The occurrence of hemangiomas is mainly related to somatic cell mutations rather than embryonic gene mutations, so the genetic risk is relatively low. Although there are a few cases where one child has hemangiomas and the second child also has them, this is a rare case and cannot be used as direct evidence of hemangioma inheritance.

In the diagnosis of hemangioma, doctors mainly rely on clinical manifestations, medical history and necessary medical examinations. For hemangiomas growing on the surface of the body, their bright red, strawberry-like appearance usually makes them easy to identify.

However, for hemangiomas that grow under the skin, medical methods such as ultrasound examination may be needed to confirm the diagnosis. During the diagnosis process, the doctor will carefully inquire about the medical history and pay attention to the growth rate and characteristics of the hemangioma, such as whether it exists at birth and whether it grows quickly.

At the same time, the doctor will perform a physical examination to observe the size, texture, skin temperature and other characteristics of the hemangioma, and use ultrasound to observe the blood flow under the skin.

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