Casi un cinco por ciento de los niños padecen angiomas o hemangiomas (que algunas personas llaman «antojos»), manchas rojizas en la piel que generalmente no se ven en el momento del nacimiento, sino que aparecen en las primeras semanas de vida.
Aunque son motivo frecuente de preocupación y consulta por parte de los padres, los angiomas son benignos y en un porcentaje alto de los casos desaparecen de forma espontánea a lo largo de la infancia. Si tu peque tiene un angioma, te contamos todo lo que deberías saber sobre estos tumores vasculares benignos.
Los hemangiomas son proliferaciones vasculares, es decir, un conjunto de vasos sanguíneos que crecen de forma anómala en la piel de los niños pequeños.
Este tumor benigno se da con relativa frecuencia en la infancia, y aunque pueden estar presentes desde el momento del nacimiento (entre un 1-3% de los casos), generalmente empiezan a hacerse visibles con el paso del tiempo, llegando a afectar a un 10% de los niños menores de un año.
Su incidencia es mayor en niñas que en niños, y también es más frecuente encontrarlos en bebés prematuros o con bajo peso al nacer, así como en caso de embarazos múltiples.
El angioma puede ser plano y presentarse como una mancha rosada o rojiza sin relieve (si es pequeña puede simular un pequeño entramado de capilares, como la foto de portada), o abultado, cuyo aspecto es una mancha roja con relieve, como la foto que podéis ver en la parte superior.
Se localizan en cualquier lugar del cuerpo, aunque es más frecuentes encontrarlos en la cabeza, la cara, el cuello y la nuca, seguido de extremidades y tronco. Más raramente afecta a superficies mucosas.
Habitualmente se trata de lesiones únicas, aunque en un 15-20% de los casos pueden ser múltiples.
Salvo algunos casos en los que su presencia es clara desde el nacimiento, el angioma comienza a manifestarse semanas o meses después como una pequeña manchita rosada que va aumentando de tamaño con el tiempo.
Su crecimiento es rápido, con una duración que varía entre los tres y los nueve meses. Luego entra en una fase de estabilización y finalmente se produce la regresión, desapareciendo casi siempre y sin dejar prácticamente señal de su existencia.
En un 30% de los casos el angioma desaparecerá antes de los tres años del niño, en un 50% lo hará antes de los cinco, y en un 70% antes de los siete años. En edades adultas es muy raro encontrar este tipo de tumor benigno.
Un tipo especial de angioma o hemangioma plano son las manchas tipo «vino de oporto» por su particular color rojo oscuro o púrpura. Son áreas de la piel extensas y lisas de formas irregulares provocadas por un exceso de vasos sanguíneos bajo la piel. Estas manchas no desaparecen sin tratamiento. Pueden ser extirpadas por un cirujano plástico o un dermatólogo pediátrico cuando el niño sea mayor.
La Asociación Española de Pediatría calcula que solo en un 1% de los casos los hemangiomas pueden suponer un peligro, aunque en su fase de crecimiento algunos pueden ocasionar complicaciones locales, especialmente en el caso de los hemangiomas faciales de gran tamaño.
Muy raramente, los hemangiomas afectan a otros órganos viscerales.
Ante la presencia de una mancha en la piel de tu bebé es importante llevarle al pediatra para su valoración. En la mayoría de los casos, su aspecto determinará el diagnóstico, aunque puede haber casos especiales en los que su localización aconseje puebas de imagen complementarias, con el fin de valorar la afectación de órganos internos o descartar malformaciones asociadas.
Como hemos comentado, en la mayoría de las ocasiones los angiomas desaparecen espontáneamente, por lo que en ausencia de compromiso de estructuras vitales se recomienda una actitud expectante, y solo en determinados casos se recomienda tratamiento:
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Es un nevo o marca de nacimiento en el cual la hinchazón de los vasos sanguíneos provoca una coloración de la piel que va de rojiza a violácea.
Los hemangiomas planos son causados por la malformación de pequeños vasos sanguíneos en la piel.
Estos hemangiomas en pocas ocasiones pueden ser un signo del síndrome de Sturge-Weber o del síndrome de Klippel-Trenaunay-Weber.
Los hemangiomas planos en etapa temprana generalmente son planos y rosados. A medida que el niño crece, el hemangioma crece con el niño y el color se puede intensificar de rojo oscuro a púrpura. Estos hemangiomas se presentan con mayor frecuencia en la cara pero pueden aparecer en cualquier parte del cuerpo. Con el tiempo, la zona puede volverse engrosada y tomar una apariencia similar a adoquines.
El proveedor de atención médica por lo regular puede diagnosticar un hemangioma plano examinando la piel.
En algunos casos, es necesaria una biopsia de piel. Dependiendo de la ubicación de la marca de nacimiento y de otros síntomas, el proveedor puede hacer un examen de la presión intraocular en el ojo o una radiografía del cráneo.
Igualmente, se puede realizar una resonancia magnética o una tomografía computarizada del cerebro.
Se han ensayado muchos tratamientos para los hemangiomas planos, como congelación, cirugía, radiación y tatuaje.
La terapia con láser ha sido la más efectiva en remover los hemangiomas planos, Este es el único método que puede destruir los diminutos vasos sanguíneos en la piel sin producirle mucho daño. El tipo exacto de láser que se utiliza depende de la edad de la persona, el tipo de piel, y del hemangioma plano particular.
Las manchas en la cara muestran una mejor respuesta a la terapia con láser que las de los brazos, las piernas o la parte media del cuerpo. Las manchas que llevan más tiempo pueden ser más difíciles de tratar.
Las complicaciones pueden incluir:
El proveedor debe examinar todos las marcas de nacimiento durante un examen de rutina.
Cheng N, Rubin IK, Kelly KM. Laser treatment of vascular lesions. In: Hruza GJ, Tanzi EL, Dover JS, Alam M, eds. Lasers and Lights: Procedures in Cosmetic Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2018:chap 2.
Dinulos JGH. Vascular tumors and malformations. In: Dinulos JGH, ed. Habif’s Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 23.
Moss C, Browne F. Mosaicism and linear lesions. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2018:chap 62.
Versión en inglés revisada por: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Traducción y localización realizada por: DrTango, Inc.
So, let’s figure out what a newborn hemangioma is and why it occurs.
Hemangioma is a benign skin tumor that consists of cells on the inner surface of blood vessels. These cells enter various organs and tissues, resulting in a formation, usually bright red or bluish in color. It can be at the level of the skin, or it can rise above it, or, conversely, be located in the depths of the tissues. The localization of the tumor can be very different: most often it is the head, face, neck, but also hemangiomas are found on the back, abdomen, arms, legs. nine0003
According to statistics, hemangiomas occur in 10 percent of newborns, and most often in girls.
The peculiarity of infantile hemangioma is that the child either has it at birth or appears in the first two months after birth. At first, the formation actively grows, but then the growth stops and the hemanginoma begins to decrease and eventually disappears. However, there are many cases when a newborn hemangioma requires complex treatment and removal. nine0003
— As for the causes of hemangiomas in newborns, there is still no exact answer to the question of why they appear, says Grigory Somsikov, head of the vascular surgery department of the children’s city clinical hospital of St. Vladimir in the city Moscow, pediatric surgeon, specialist in pediatric vascular pathologies . “There are only theories. One of them is the viral diseases of the mother during pregnancy, namely in the first trimester, when the formation of the vascular system of the unborn baby takes place. The risk of hemangiomas is also higher with the following factors:
However, hemangiomas often occur in quite healthy children when the pregnancy proceeded safely, without pathologies.
There are several types of hemangiomas in newborns. nine0003
Infantile (infantile) hemangioma. It consists of capillaries, may be purple or bluish in color, of different sizes, may be flat or slightly raised above the skin. If you press on the hemangioma, it turns pale. Education can be located on any part of the body, but most often occurs on the head, face, neck.
Combined hemangioma. It consists of pathological vascular formations, which are located both on the surface of the skin and in its deep layers, subcutaneous fat. nine0003
Congenital hemangioma. This is a special type of hemangiomas, when a newborn is born immediately with a vascular tumor, as a rule, it is quite large. Color — dark burgundy with a white area in the center. Such formations are rare.
— In addition, hemangiomas can form on internal organs, such as the liver, spleen, brain, — says Grigory Somsikov. — It is worth noting that internal hemangiomas occur, as a rule, when there are a large number (more than 5) of hemangiomas on the skin. nine0003
As we have already said, hemangioma can appear on any part of the body of a newborn.
Formations on the scalp occur in the vast majority of cases of hemangiomas in newborns. It can be flat and barely noticeable (if the newborn has a fairly strong hairline, then the formation may not be noticed immediately), or it can be quite large, rising strongly above the skin.
On the face, hemangiomas are also very common. Moreover, they can be located on a variety of its parts: the bridge of the nose, cheeks, chin, eyelids, lips, ears. Hemangiomas located on the face always require special attention, as they can adversely affect the development of vital functions, such as vision, hearing. Such hemangiomas require early complex treatment. Formations on the neck can also be especially dangerous, as they can grow into the larynx, trachea, disrupting breathing, making it impossible to eat. nine0003
Lesions are less common on this part of the body. As a rule, simple flat hemangiomas on the back do not cause discomfort to the newborn. But larger formations can be dangerous, because due to friction on clothes, constant squeezing while the child is lying, sleeping, increases the risk of ulcers, hemangioma trauma, and bleeding. Such formations require complex treatment.
Hemangiomas do not occur often on the legs. But they can also cause discomfort and have a risk of injury if, for example, they have a large convex shape, are located on the joint, there is a risk of damage to the joint and bone tissue. nine0003
The same applies to hemangiomas on the arms. Particularly dangerous and requiring treatment can be combined formations located in the armpit, on the joints.
On the eyelids, hemangiomas occur quite often and require treatment in almost one hundred percent of cases, since during the active growth phase they can damage the eye of a newborn, lead to negative consequences in the development of vision. But the tactics of treating or removing hemangioma in this area should be chosen by the doctor especially carefully, since any intervention in the eye area also has serious risks. nine0003
Hemangioma on the lip is not only a cosmetic defect. Such a formation can be dangerous, because as it grows, it can prevent the newborn from sucking, make breathing difficult, and close the entrance to the nasal cavity.
Any newborn who has a hemangioma should be seen regularly by a vascular specialist. It is he who makes the final diagnosis and chooses the tactics of treating hemangioma, which, if necessary, should be carried out in the department of vascular or pediatric surgery. Depending on where the hemangioma is located, you may need to consult a pediatric gynecologist, urologist, otolaryngologist, ophthalmologist, maxillofacial surgeon, thoracic surgeon (he deals with the treatment of chest organs — lungs, heart, esophagus and others). nine0003
“The choice of a hemangioma treatment method depends on many factors,” says Grigory Somsikov, head of the vascular surgery department of the St. Vladimir Children’s City Clinical Hospital in Moscow, pediatric surgeon, specialist in pediatric vascular pathologies. — It is important to take into account the age of the child, the location of the hemangioma, its size, shape, growth trend. It is important to understand that it is in the first months of life that hemangiomas are most easily cured. First of all, formations that are located on the face or in the anogenital region, joints and are growing rapidly are subject to early correction and complex treatment. As well as hemangiomas, which are prone to injury, ulceration. nine0003
In the arsenal of doctors today there are several ways to work with hemangiomas. Consider their features, as well as the pros and cons.
Local therapy with a beta-blocker. It is given with Timolol (often in the form of a gel) and shows very good results. Thanks to its use, it is possible to stop the growth of hemangioma in newborns and achieve its involution (reverse development).
Beta-blocker treatment: by mouth. This method is used, as a rule, when a child has a large hemangioma, including ulcerations, or small formations, but having a critical localization, as well as combined and deep forms of hemangiomas. nine0003
Laser removal of hemangioma. A very effective, safe and bloodless method for the removal of hemangiomas. It is important to note that in the case of hemangiomas, a special type of laser is used — a pulsed dye laser. This is the only type of laser approved for use in the treatment of hemangiomas in young children. The laser gradually coagulates the vessels of the hemangioma, removes the layers of the tumor.
— It removes hemangiomas without damage to the skin, bloodlessly, after manipulations no crusts or scars form, — says Grigory Somsikov. – Laser treatment is provided free of charge under the compulsory medical insurance policy. nine0003
There are contraindications for laser use: it is a malignant disease, photodermatitis, epilepsy, diabetes mellitus, infectious diseases.
Cryodestruction. This is not the method of choice for the treatment of hemangioma, however, it is also used in some clinics in Russia. During cryodestruction, hemangioma is exposed to carbon dioxide or nitrogen. After that, a depression forms on the surface of the skin, over time it turns into a “crust”, then it disappears, an atrophic scar is formed. Therefore, the use of this method is possible only if the hemangioma is not located on the face, has a small size (no more than 2-2.5 mm) and there is no possibility to use other methods of treatment. It should be noted that in Europe and the USA, the method of cryodestruction in the treatment of infantile hemangiomas has not been used for a long time. nine0003
There are several other treatments that have been used in the past but are now considered unsafe and inappropriate. These include x-ray therapy, sclerotherapy (the introduction of drugs into the cavity of the tumor vessels), hormone therapy, and surgical removal of the formation. Due to serious side effects, these methods cannot be justified in the presence of more modern and safer methods for the treatment of hemangiomas.
As already noted, neonatal hemangioma has several phases of development. After the appearance in the first weeks of life, it actively grows. As a rule, the growth of education stops at 6-7 months. Then, for some time, the hemangioma is in an unchanged state, and after a year — one and a half years, the phase of involution begins, that is, the reverse development of the hemangioma. And over time, some of the formations pass. This usually happens by 5-10 years of age. nine0003
— The duration of the passage of a hemangioma depends on how much it has grown, where it is located, one formation may disappear in three years, the other in 7 years, says Grigory Aleksandrovich. “But it is important to understand that there are hemangiomas that go away easily and quickly and do not even leave any marks, and there are those that can leave a cosmetic defect that is not compatible with a comfortable social life. And no one can say how education will behave, how quickly and strongly it will grow at the initial stage, when the hemangioma has just appeared. Once again, I note that hemangioma is best treated in the first three months of life. But the decision on the need for treatment and correction of education is made in each case by the doctor and parents jointly, taking into account all possible risks and consequences. nine0003
Hemangioma (hemangioma) is a benign tumor formed from abnormally developed cells of the inner surface of blood vessels. It is a purple-lilac neoplasm on the surface, in the thickness of the skin and under it.
Affects the endothelium in any part of the body, most often in the head, neck, spine (lower thoracic and upper lumbar regions). More often diagnosed in infancy. Source:
Infantile hemangioma: classification, clinical picture and methods of correction. Sheptiy O.V., Kruglova L.S.: Russian Journal of Skin and Venereal Diseases, 2016, less often in adults. Can grow. In 70% of cases, it undergoes spontaneous regression and does not require treatment.
Enlarging hemangiomas in open areas of the body are a cosmetic defect and cause psychological discomfort of varying severity. In 10% of cases, they can be localized near the liver, kidneys, lungs, and other vital structures. In the process of growth, they are squeezed, which poses a serious danger. nine0003
Hemangiomas can cause tissue necrosis (necrosis), so the lesion becomes the entrance gate for infection. Accession of a purulent process can cause sepsis. With hemangioma of the bones, their destruction is possible. In addition, the process can contribute to impaired blood clotting and the formation of blood clots. Malignancy is possible — the degeneration of hemangioma into cancer.
With timely visit to the doctor, the neoplasm is successfully treated in 100% of cases Source:
What a pediatrician needs to know about infantile hemangiomas. Zakharova I.N., Kotlukova N.P., Roginsky V.V., Sokolov Yu.Yu., Zaitseva O.V., Maykova I.D., Idrisova G.R., Pshenichnikov I.I.: Medical Council , 2016.
There are 2 types of hemangiomas — congenital — formed during fetal development — and acquired; acquired in early childhood are often called infantile. By structure, single and multiple hemangiomas (hemangiomatosis) are distinguished, by structure — capillary, arterial and venous.
By education, they are local and segmental. Local hemangiomas grow from one point, differ in smooth edges and relatively small sizes. Segmental — large, with a «torn» edge, often develop as part of combined pathologies of the chest, aorta, pelvis and sacrum, heart defects, etc.
Hemangiomas are distinguished by localization:
The exact causes of hemangiomas have not yet been identified; it is generally accepted that their appearance can provoke a violation of the intrauterine development of the fetus due to a viral illness of the mother or oxygen starvation. Additional risk factors for the formation of congenital hemangioma:
In adults, neoplasms can be caused by hereditary predisposition, diseases of the cardiovascular system, excessive ultraviolet radiation, and an increased level of female estrogen hormones. nine0003
Hemangioma is a red spot, in the center of which there is a dot, and a network of small vessels emanate from it. Usually the neoplasm is smooth, can protrude 1-2 cm above the skin. When pressed, it becomes pale, but quickly returns to its normal appearance. A characteristic symptom is uneven temperature: on palpation, the hemangioma is noticeably warmer than the surrounding areas of the body. Clinically, it may not manifest itself in any way and be detected by chance during examination.
The disease proceeds in phases — growth, stabilization, optionally — spontaneous regression. Complications are possible in the growth and stabilization phases of hemangioma. If a neoplasm grows near a functional organ, its work may deteriorate — for example, in the periorbital zone it can contribute to a decrease in vision, and on the mucous membrane of the larynx — respiratory obstruction.
If the hemangioma is localized near the nerve ending, with its growth, weakness and numbness of the limbs, disruption of the bladder and gastrointestinal tract are possible. Large spinal hemangiomas can cause pain and increase the risk of compression fractures. Neoplasms are easily injured, so they can cause bleeding. nine0003
The primary diagnosis is made by a dermatologist based on the results of visual examination and palpation. For differential diagnosis (detection of the depth and features of the structure of the neoplasm), the following are used:
The main method of treatment is surgery. In addition to cosmetic, there are medical indications for this:
The priority is sparing minimally invasive techniques for removing hemangioma or vascular surgery methods to reduce blood flow in it. Excised tissues are sent for histological analysis. nine0003
If the neoplasm is small, it is possible to use electrocoagulation, radio wave or laser surgery, cryodestruction with liquid nitrogen. In some forms of hemangiomas, sclerotherapy is effective — «gluing» damaged capillaries by injecting special solutions Source:
Hemangiomas and vascular malformations. Modern theories and medical tactics. Goncharova Ya.A.: Health of a child, 2013.
In case of slow-growing tumors with a low risk of malignancy, conservative drug therapy with drugs from the group of beta-adrenergic receptor blockers is possible. Source:
Wong A., Hardy K., Kitajewsky A. Propranolol causes functional changes in hemangioma stem cells and hemangioma endothelial cells // Abstract book. ISSVA the 19th International Workshop on Vascular Anomalies. — 2012. — p. 245 .. In some cases (if the neoplasm does not grow, does not bother, or there is a tendency to its reverse development), they resort to expectant tactics.
To verify the effectiveness of the treatment, after its completion, a control study is prescribed — ultrasound, tomography or dermatoscopy. To consult with a specialized specialist in St. Petersburg, fill out the online form. nine0003