Angiomas and Vascular Anomalies Unit

The exact causes of the abnormal vascular proliferation that gives rise to infantile haemangiomas are not fully understood. What is known is that these angiomas or strawberry birthmarks are much more common in girls and, according to medical literature, may follow an autosomal dominant inheritance pattern. This means that if one parent carries the gene or genes associated with the anomaly, the child has a 50% chance of inheriting it.

Premature babies and those born with low birth weight are also more likely to develop angiomas than infants born at term with a normal weight.

It has also been demonstrated that strawberry birthmarks express a marker known as GLUT-1, a glucose transporter found in the blood–brain barrier and in red blood cells.

This marker provides specialists with highly valuable information when differentiating angiomas from other types of vascular malformations, which is a key factor in selecting the most appropriate treatment. Although most infantile haemangiomas are reddish in colour, some may appear bluish. These tend to be located deeper in the skin and require thorough assessment to determine whether they are benign tumours or another type of vascular malformation with a less favourable prognosis.

Strawberry birthmarks follow a very similar course in most patients. Before becoming visible, a faint pink, bluish or whitish patch may appear, often going unnoticed. In the next phase, the angioma becomes raised and gradually acquires its characteristic red colour.

After a period of rapid vascular proliferation, growth and maturation, the infantile haemangioma enters a regression phase. Growth stops and the lesion gradually fades. Around 50% resolve by the age of five, 70% by the age of seven, and over 90% leave no visible trace by the age of nine. If any residue remains, it is usually mild, such as a telangiectasia or redundant skin.

In addition to clinical examination and assessment of the patient’s medical and family history, infantile haemangiomas are diagnosed using Doppler ultrasound or, when necessary, MRI or analysis of the GLUT-1 marker.

The aim of these tests is to differentiate strawberry birthmarks from other vascular malformations or tumours and to obtain detailed information regarding their location, extent, aesthetic or functional implications and likely evolution.

In most cases, infantile angiomas do not require specific treatment, as they are benign lesions that tend to resolve spontaneously over time.

Nevertheless, close monitoring is essential to confirm favourable progression, detect early changes and treat complications should they arise. Although angiomas are benign, ulceration can occur in approximately 13% of cases, particularly when lesions are located in areas subject to friction, such as the buttocks.

As a result, a watchful waiting approach is usually adopted, with clinical intervention reserved for cases at high risk of ulceration and subsequent scarring or deformity. At the Grupo Pedro Jaén Vascular Anomalies Unit, each case is assessed individually to determine the most appropriate management strategy.

When medical treatment is required, earlier intervention is associated with a better response and outcome, highlighting the importance of early specialist assessment.

Medications for haemangiomas

Different types of medication may be used depending on the size, location and characteristics of the lesion.

Oral or topical treatment

These therapies help to halt haemangioma growth and promote regression. Topical formulations are particularly useful for small, superficial lesions at an early stage, provided they are not located on mucous membranes and are not ulcerated.

Localised injectable treatment

Medications can be injected directly into the haemangioma to achieve highly localised size reduction. This approach is especially suitable for well-defined cutaneous haemangiomas located on the ear, nasal tip, cheeks, eyelids or lips and may be combined with oral therapy in selected cases.

Other pharmacological options

Additional therapies may be used in complicated haemangiomas to modulate the immune system, inhibit angiogenesis (formation of new blood vessels) or induce apoptosis (programmed cell death), thereby controlling the vascular component of the lesion.

Laser treatment for haemangiomas

Vascular laser therapy offers excellent results in involuted (residual), abortive and ulcerated haemangiomas, promoting rapid re-epithelialisation and lesion closure. In some cases, it may be combined with beta-blockers depending on the patient.

Vascular lasers can also be combined with other laser modalities to treat skin thickening, improve scarring (ablative and non-ablative fractional lasers) and reduce residual sequelae.

For this type of treatment, the Grupo Pedro Jaén Vascular Anomalies Unit works closely with the Laser Unit, the largest private laser platform in Europe, which collaborates transversally with all medical specialties within the group.

Surgery for infantile haemangiomas

Although strawberry birthmarks generally have an excellent prognosis, surgery may be required in exceptional cases involving serious complications, such as recurrent bleeding, involvement or deformation of adjacent structures, or impairment of vital functions such as vision.

Surgical cases are referred to the Grupo Pedro Jaén Plastic Surgery Unit, where the most appropriate technique is selected on an individual basis according to the patient’s circumstances and the size and location of the lesion.

Also known as cherry angiomas or microangiomas, these benign vascular lesions usually appear on the trunk and upper limbs. They have a strong hereditary and hormonal component and do not develop in childhood, but rather increase with age, which is why they are also referred to as senile angiomas.

They are more common in individuals with fair skin, although other phototypes may also be affected. They are usually slightly raised and rarely exceed one or two millimetres in diameter, although larger lesions can occur.

The exact cause is not fully understood, but cherry angiomas appear more frequently in very fair-skinned individuals with inadequate sun protection. Hormonal changes during pregnancy have also been associated with their development, although they usually regress after delivery.

Diagnosis is primarily clinical, although digital dermoscopy may be used to exclude malignancy and confirm the diagnosis by revealing subtle structural features not visible to the naked eye.

As cherry angiomas are benign, treatment is not required unless they pose an aesthetic concern or bleed frequently due to friction or minor trauma.

When treatment is indicated, vascular laser therapy is the treatment of choice. As with strawberry birthmarks, the laser selectively targets red-pigmented vascular structures without damaging surrounding tissue. The procedure is quick, virtually painless and requires no downtime.

Laser treatment for cherry angiomas is neither uncomfortable nor painful and does not require downtime or time off work.

Although cherry angiomas are benign and not moles, monitoring is recommended if lesions grow or develop irregular borders, as this may indicate a different diagnosis requiring specialist assessment.

Venous lakes are mainly associated with chronic sun exposure. Less commonly, they may result from trauma or genetic syndromes, in which case they are classified as vascular malformations rather than angiomas.

Venous lakes do not require treatment for medical reasons, only for aesthetic concerns or when larger lesions are prone to bleeding.

Treatment options include cryotherapy, sclerotherapy or surgical excision. However, the most effective and safest option is vascular laser therapy using a Nd:YAG laser, which has a longer wavelength capable of coagulating deeper lesions.

In some cases, a combination of vascular lasers may be required to optimise results. Treatment is virtually painless and usually consists of one main session and a follow-up session to refine the outcome.

This device uses a longer wavelength that coagulates the lesion, which is located at a deeper level than other types of angiomas. In some cases, it may be necessary to combine two vascular lasers to achieve a more satisfactory result. In all cases, the treatment is virtually painless and typically involves one treatment session, with a second session to refine the outcome if required.

The Grupo Pedro Jaén Laser Unit offers a wide range of laser systems, allowing the most appropriate combination to be selected for each lesion.

What is the difference between a haemangioma and a vascular malformation?

Because haemangiomas are vascular anomalies, terminology is often used in a confusing way for patients. Essentially, haemangiomas are benign vascular tumours of an intense red colour that appear a few days after birth. They grow during the first year of life and may later decrease in size or even disappear completely.

By contrast, vascular malformations are present from birth. Over time, they tend to become darker and hypertrophic (thickened in appearance) and never resolve spontaneously.

Can haemangiomas be prevented?

No. Haemangiomas are relatively common anomalies related to the immaturity of the vascular system. In fact, it is estimated that around 20% of premature babies develop an angioma. There is therefore no way to prevent their formation.

Which specialist should I see if I have a haemangioma?

Several specialists may be involved in the management of a haemangioma, depending mainly on its location and size. At the Grupo Pedro Jaén Angiomas Unit, each lesion is individually assessed to determine whether it is an angioma or a vascular malformation and to refer the patient to the most appropriate unit. In most cases, haemangiomas can be managed entirely within our Angiomas Unit and Laser Unit. However, some cases may require treatment within the Plastic Surgery Unit or the Vascular Malformations Unit.

Can a haemangioma reappear?

No, provided that the diagnosis is correct—haemangiomas are often initially confused with vascular malformations until the correct diagnosis is established—and that the treatment prescribed by the specialist is completed without premature interruption.

What is a port-wine stain?

Also known as flat angiomas, port-wine stains are vascular malformations present from birth. They are most commonly located on the face but may appear anywhere on the body. They are initially pink in colour and gradually darken over time, often becoming raised after the age of 20. One of the main advantages of laser treatment is its ability to act selectively on affected tissues without damaging healthy skin or altering surrounding structures.

The mechanism of action is based on the laser’s affinity for the red colour of haemoglobin. In this way, vascular lasers destroy abnormal blood vessels and reduce the size, colour and texture of the lesion over a variable number of treatment sessions.

The content of this page has been prepared by the Communication Department and the Medical Team of Grupo Pedro Jaén, in line with our editorial commitment to ensuring the accuracy and up-to-date nature of the information provided.

References on angiomas:

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2. Buslach N, Foulad DP, Saedi N, Mesinkovska NA. Treatment Modalities for Cherry Angiomas: A Systematic Review. Dermatol Surg. 2020 Dec;46(12):1691-1697. doi: 10.1097/DSS.0000000000002791. PMID: 33252464.

3. Rodríguez Bandera AI, Sebaratnam DF, Wargon O, Wong LF. Infantile hemangioma. Part 1: Epidemiology, pathogenesis, clinical presentation and assessment. J Am Acad Dermatol. 2021 Dec;85(6):1379-1392. doi: 10.1016/j.jaad.2021.08.019. Epub 2021 Aug 19. PMID: 34419524.

4. Jesús Alberto Sabando Carranza, Izaro Almandoz Irigoyen, Aitziber Arrugaeta Zabaleta, Experiencia en el tratamiento de los puntos rubí o angioma capilar adquirido en una consulta de atención primaria, FMC – Formación Médica Continuada en Atención Primaria, Volume 28, Issue 7, 2021, Pages 397-398, ISSN 1134-2072, DOI: 10.1016/j.fmc.2020.06.005.

5. Dua Cebeci, Seide Karasel, Şirin Yaşar, Venous Lakes of the Lips Successfully Treated With a Sclerosing Agent 1% polidocanol: analysis of 25 report cases, International Journal of Surgery Case Reports, Volume 78, 2021, Pages 265-269, ISSN 2210-2612, DOI: 10.1016/j.ijscr.2020.12.057.

6. H.E. John, H.S. Phen, P.J. Mahaffey, Treatment of venous lesions of the lips and perioral area with a long-pulsed Nd:YAG laser, British Journal of Oral and Maxillofacial Surgery, Volume 54, Issue 4, 2016, Pages 376-378, ISSN 0266-4356, DOI: 10.1016/j.bjoms.2015.06.014.

7. Sebaratnam DF, Rodríguez Bandera AL, Wong LF, Wargon O. Infantile hemangioma. Part 2: Management. J Am Acad Dermatol. 2021 Dec;85(6):1395-1404. doi: 10.1016/j.jaad.2021.08.020. Epub 2021 Aug 19. PMID: 34419523.

8. Mariani LG, Ferreira LM, Rovaris DL, Bonamigo RR, Kiszewski AE. Infantile hemangiomas: risk factors for complications, recurrence and unaesthetic sequelae. An Bras Dermatol. 2022 Jan-Feb;97(1):37-44. doi: 10.1016/j.abd.2021.05.009. Epub 2021 Nov 27. PMID: 34848114; PMCID: PMC8799848.