Weighing the Options
As many as one in 10 hemangiomas are serious enough that parents should consult a specialist as soon as possible. These include protruding ones near the nose, eyes, lips, or diaper area; ones that cover a wide territory of skin; and those that ulcerate and bleed. Children who have five or more hemangiomas of any size should have more evaluation because they have a higher risk of also having internal hemangiomas, especially in the liver.
Steroid medication (either oral or injected) is one of the main treatments to reduce the size of a large hemangioma. Parents may worry about side effects, such as suppression of the immune system or slowed growth, but doctors say that the benefits outweigh them -- and that there's a limited window of time to intervene while a child's hemangioma is still enlarging. "Steroids are extremely effective, and they rarely cause any complications," says Parents advisor Amy Paller, MD, chief of dermatology at Northwestern University Feinberg School of Medicine, in Chicago. When steroids don't work, doctors may also use two cancer drugs -- interferon or vincristin -- or laser treatments. Lasers are often used to "mop up" leftover blood vessels or to fade the red color on flat hemangiomas that are on the face. Doctors may recommend surgery for large hemangiomas whose removal won't leave prominent scars or when a hemangioma?s growth is endangering a child's eyesight or breathing.
Waiting It Out
By the time Amber Bergeron was 3 months old, the hemangioma on the side of her nose had grown from a tiny scratch to the size of a grape -- and an ophthalmologist worried that it was obstructing her vision.
Her father, Peter, a center fielder for the Philadelphia Phillies, happened to meet another player whose daughter had a similar growth on her face. He suggested that the Bergerons contact the Vascular Birthmark Foundation, which referred them to Dr. Waner, in New York City. Dr. Waner recommended that Amber have the growth removed because it was so close to her eye, and she had the surgery when she was 4 months old. "She's now 21 months and looks beautiful," says her mother, Jennifer. "She healed faster than we ever thought she would."
Often it's parents who are most troubled by the birthmarks. After all, everyone envisions having a perfect baby, and other people's reactions can be upsetting. "When we went out in public, strangers would stare and make comments like, 'What happened to your baby?' " says Lisa Aires, of Berkeley Township, New Jersey, whose daughter, Kristen, had a birthmark the size of a quarter on her scalp. After consulting with different doctors, she and her husband decided not to treat the hemangioma, and when Kristen was 11 months old, it began to shrink. By the time she was 2, her hair had grown enough to cover it.
Fortunately, there are multidisciplinary medical groups springing up at major children's hospitals focused on these sorts of birthmarks, and more pediatricians are updating their attitudes about them. "While the Internet can provide useful information, many Web sites scare parents because they focus on the most severe cases," says Dr. Frieden. "It's actually reassuring to remember that most hemangiomas don't grow large and won't need any treatment."