Introduction

Also known as infantile haemangiomas, strawberry haemangiomas are vascular birthmarks composed of blood vessels. They are called strawberry hemangiomas due to their raised red/purple appearance resembling strawberries on the skin. They are a common occurrence among newborns, with a prevalence ranging from 5 to 10% of infants.¹ These birthmarks are more common in girls and premature babies, born before 37 weeks of gestation.² Even though haemangiomas can develop at any age, they are usually observed during the first few weeks or months of life. 

Haemangiomas tend to be harmless, but they may develop complications that require medical attention. Understanding and identifying the features of these birthmarks is key to managing these growths and alleviating unnecessary anxiety from parents or caregivers. 

Characteristics of strawberry haemangiomas 

Appearance

Strawberry haemangiomas are distinct birthmarks usually presented as raised, red/purple growths on the skin with a bumpy texture. The size and colour of these marks vary among individuals, ranging from a few millimetres to several centimetres in size. The depth of colour depends on the number of blood vessels located within the lesion. 

Growth patterns

Strawberry haemangiomas have three distinct growth phases:³

• Rapid growth phase: Within the first few months of appearing, strawberry haemangiomas can undergo a period of rapid growth, called the “proliferative phase”, in which they expand in size and become more prominent
• Plateau phase: After the proliferative phase, most strawberry haemangiomas enter a “plateau phase”, during which the growth rate slows and stabilises
• Involution phase: The final stage is characterised by colour fading and a decrease in size

Causes and risk factors

Underlying causes

The cause of strawberry haemangioma development is not fully understood, but is believed to be caused through abnormal clustering of blood vessels during foetal development. 

Risk factors

Prematurity and low birth weights have been directly associated with an increased likelihood of developing strawberry haemangiomas.⁴

Genetic predisposition

Research has suggested they can be passed on through genetics, however, more research is needed to confirm this.⁴

Diagnosis

Clinical examination

A thorough clinical examination is the main method of diagnosis. A clinician will evaluate the appearance, growth pattern, size, and location of this birthmark, along with discussing individual and family medical history.³

Imaging techniques

Imaging techniques may be used to make better a diagnosis where the haemangioma’s size or location makes it challenging for visual inspection and clinical examination.

• Ultrasound can provide detailed information on the depth and vascular characteristics of strawberry haemangiomas
• Magnetic resonance imaging (MRI) and computed tomography (CT) scans can also be considered but are usually reserved for more complex cases

Differential diagnosis

Strawberry haemangiomas share similarities with other skin conditions such as port-wine stains, pyogenic granulomas, or other vascular abnormalities.

Treatment options

The varied presentation of strawberry haemangiomas makes their management and treatment dependent on a case-by-case basis.

Observation and monitoring

The first step is careful monitoring of the size and shape of the strawberry haemangioma and ensuring it is not painful or causing functional restrictions. If there are rapid changes in appearance, it becomes painful or starts to cause restriction, it is advised to seek medical help.³

Medical interventions

Topical treatments

Corticosteroid creams or ointments can be directly applied to the surface of the hemangioma with the goal of reducing inflammation and slowing growth.^5,6

Oral medications

Propranolol, a beta-blocker, may be recommended for reducing the size and appearance, especially if it is rapidly growing.^5,6 

Surgical removal

In the case of functional or cosmetic concerns, surgical removal can be performed.⁶

Laser therapy

Laser therapy can help reduce the colour and thickness of the lesion by targeting the blood vessels within the growth without affecting the surrounding skin.

Prognosis and outcomes

Strawberry haemangiomas tend to regress and shrink over time. This usually occurs during the child's first two years of life, however, this process can take several years and may vary among individuals. In some cases, they can completely fade. 

Where complications are seen, such as with ulceration, scarring can occur. However, this is dependent on the size, depth, and the individual's skin type.

When is it right to seek medical attention?

Recognition of when medical attention is needed for children can reduce unwanted complications and permanent marking. Strawberry haemangiomas can occur on any part of the body, however frequently form on the head and neck and do not cause any problems. If they form on the face, or on a moving part of the body they may require medical attention due to potential complications that can include:

• Ulceration can occur if the area is knocked, scratched or becomes infected. This causes the skin to become sore and painful. Careful monitoring and prompt medical attention are essential is these cases
• Bleeding can occur due to them being highly vascular growths, especially if subjected to trauma. Bleeding haemangiomas can be managed by applying firm pressure to the area for 10 minutes. Prompt medical help should be sought if you cannot stop the bleeding
• Pain is not a common symptom and medical advice should be pursued if the haemangioma becomes painful when touched or during the daily routine

If there are vision or breathing issues in your child, you should seek an immediate medical evaluation.

Prevention and management

It is important to note that strawberry haemangiomas cannot be prevented. However, it is possible to optimise management and reduce the risk of complications. 

Avoiding trauma

• Protective clothing: Covering the haemangioma area with clothing, preferably soft, non-irritating fabrics to protect it from rubbing
• Gentle handling: Always be cautious when handling or washing the haemangioma area
• Babyproofing: Ensuring your home is as safe as possible to help prevent accidents that may lead to trauma

Sun protection

Ultraviolet (UV) rays from sun exposure can cause pigment changes in the skin, and consequently, in the haemangioma. Where possible, try to avoid direct sunlight and apply a high SPF factor sunscreen generously and regularly to the haemangioma and its surrounding skin.

Psychological support

Parents and caregivers should be attuned to their child’s emotional well-being and mental health because these visible birthmarks can impact the individual’s confidence and cause emotional distress. Providing emotional support by encouraging open conversations and addressing any haemangioma-related concerns along with professional medical help is an invaluable tool for individuals to cope with the psychological burden that this condition might bring.

FAQs

Do strawberry haemangioma go away?

Strawberry hemangiomas typically shrink and fade over time, especially after a few years of life. 

The extent and speed of regression varies from person to person, however, they are expected to have regressed significantly by the time children reach school age. Some may experience full resolution, while others may leave behind minor scarring or changes in skin texture. In rare instances, they may not fully resolve, and medical intervention may be considered. 

How rare is a strawberry haemangioma?

Strawberry haemangiomas are relatively common vascular birthmarks. It is estimated that approximately 4 to 10% of infants develop them. These haemangiomas are more common in premature infants, with a higher incidence in females.

What is the difference between a haemangioma and a strawberry haemangioma?

Haemangioma and strawberry haemangioma are terms often used interchangeably, but they refer to slightly different variations of the same type of birthmark, and a few factors allow their differentiation:

• Haemangioma: general term for a common type of vascular birthmark referring to a benign growth of blood vessels that can appear in various forms and depths within the skin
• Strawberry Haemangioma: also known as infantile haemangiomas, typically referring to a superficial, raised, and red/purple birthmark. They usually occur in infants and children and can appear shortly after birth or in the first few weeks of life. The name "strawberry" is related to their appearance, resembling the texture and colour of a ripe strawberry

Summary

Strawberry haemangiomas are common non-cancerous growths characterised by their raised, red/purple appearance. While generally benign, they can occasionally lead to complications including bleeding, ulceration, and emotional distress. Early diagnosis and appropriate management can ensure the best possible outcomes with usually little to no scarring. Monitoring for signs of complications is crucial to ensure prompt medical interventions. Moreover, addressing emotional concerns plays a major role in the long-term management of haemangiomas. Well-informed, proactive parents and caregivers are key in helping children navigate this experience with confidence and resilience.