As Dermatologist – Venereologist Dr. Konstantina Mamali explains “hemangiomas appear as a diffuse pink or purplish-red area and are usually located on the face, head and neck. Although the modern medical community maintains that hemangiomas should be left untreated, there are cases in which medical intervention and treatment of hemangioma is deemed necessary. This is particularly the case in cases where hemangiomas cause functional or psychological problems in young children.
A hemangioma can sometimes resemble a simple redness or an injury, so that it is not given the necessary attention. For this reason, it is particularly important to pay attention to such signs. Especially the parents, should check the body of the young child and contact the dermatologist if they see any worrying sign.
Hemangiomas can occur in many forms. They can occur superficially or in deeper layers. They can also occur in isolation or as a result of another condition. If it occurs near the surface of the skin then it is called a “superficial hemangioma”. These hemangiomas are often red in color and have an uneven surface. Hemangiomas in the deeper layers are more difficult to find and are called ‘deep hemangiomas’. They are usually blue in color and have a smoother surface than superficial ones.
There are also cases in which the hemangioma is large enough in size to cause an unsightly effect, leading to socialization problems. An example is the existence of a hemangioma on the upper lip, a particularly prominent point and extremely important for the person’s self-confidence. In fact, there are cases of hemangioma occurring in the nose area, which can lead to serious respiratory problems or even visual problems if they spread. In rarer cases, the hemangioma may appear in the groin, developing inflammation and causing pain to the person who develops it.
Hemangiomas are treated in the following ways:
- Laser treatment: treatment using Nd-YAG Laser has been proven to be extremely effective in the treatment of hemangiomas. During laser treatment, the removal of hemangiomas is achieved while protecting the surrounding tissue and skin. The use of Laser achieves the elimination of fine lines, as well as more resistant spider veins, with greater size and depth. Also, the Pulsed Dye Laser is ideal for treating Port Wine Stain hemangiomas.
- Medication: this is usually medication that slows down the growth of the hemangioma, which is why it is given during the growth phase. It is recommended in cases where the hemangioma is life-threatening for the infant or interferes with vital functions of the body.
- Surgical removal: recommended mainly in cases where the hemangioma appears on the face and when removal is carried out at a very young age. However, parents as well as people who are going to have surgery should be aware that surgical removal is very likely to scar the skin.
What are hemangiomas?
In their general form, hemangiomas are a group of non-functioning blood vessels in the skin. They originate from cells which, when they proliferate normally, form normal blood vessels. However, when there is an intense and uncontrolled proliferation of these cells, the formation of hemangiomas is caused.
Often, hemangioma is confused with hematoma, but this is different from hemangioma as it involves the accumulation of blood at a point outside the blood vessel and usually within a tissue.
What are the advantages of laser hemangioma treatment?
The advantages of Laser treatment are as follows:
- Fast and painless method
- Quick and painless
- Fastest healing in cases of bleeding, compared to other methods
If necessary, the CO2 Laser, the Sclerotherapy method or even the surgical excision of hemangiomas may be used.
How do hemangiomas progress?
Hemangiomas mainly appear during infancy, shortly after birth, and they increase strongly during the first 6-10 months of the baby’s life (growth phase). The incidence of hemangiomas is higher in babies born prematurely and is more common in girls, especially those with fair skin color. Sometimes hemangiomas disappear on their own and disappear completely during childhood (regression phase). Hemangiomas usually increase in size in the first 10 months when they are superficial, while deep hemangiomas continue to increase in size for up to 18 months.
Hemangiomas can occur anywhere in the body, but it has been shown that 60% of hemangiomas occur in the head region, while 25% of cases have been recorded in the trunk. In females, the highest number of hemangiomas is found in the neck.
Although, as mentioned above, sometimes hemangiomas disappear on their own, there are times when their removal is necessary. As the hemangiomas are located on the surface of the skin, a simple friction (e.g. from clothing) can cause them to bleed. This, combined with the possible hearing, vision and skeletal deformity problems they can cause, makes it necessary to treat them. At the same time, the sense of difference on the part of the child once he or she realizes that there is something strange about his or her skin can cause the child serious psychological problems and lead to marginalization.
Even in cases of hemangioma occurring in adulthood (mainly due to heredity), it is recommended to remove it as if it bleeds frequently, there is a risk of infection.
What are the types of hemangiomas?
The most common types of hemangiomas are the following:
- Capillary hemangioma of infancy or angiomatous nevus: It takes the form of a soft small red or purple-colored nodule that develops from birth and usually disappears on its own by the fifth year of age. The main location of these is on the face and neck. Facial capillary hemangiomas are most commonly seen in premature or low birth weight infants and their incidence rate varies according to sex (females are three times more likely to develop capillary hemangiomas than males). The presence of many such hemangiomas on the skin may also hide vascular lesions in internal organs such as the digestive system, liver or central nervous system.
- Smooth Hemangioma or Port-Wine Stain: Appears as a red or violet-colored and irregularly shaped area that is evident from birth. It owes its name to the Porto wine, as their color is quite similar. It is usually found on the face – a smooth facial hemangioma – and may occupy a large area of the face and even extend to the eyelids. Several times it occurs inside the oral cavity, so it is recommended that the mouth be checked during the first months of the infant’s life. Alongside the smooth facial hemangioma, vascular malformations of the eyes, central nervous system and even bones may coexist. Often it can be part of a syndrome, such as Sturge-Weber syndrome. It appears immediately after birth and remains throughout the person’s life. It can be diagnosed with the naked eye, but a biopsy is usually performed to confirm the diagnosis. Smooth spots do not go away on their own, so therapeutic intervention is required.
If treatment is started during childhood, then the improvement after the sessions can be as high as 75%, and cases with 100% improvement have been recorded.
- Gerontological hemangioma or cherry spot: Also known as “Morgan’s spots” or chickenpox hemangiomas, they are very common and are seen as red small ellipses on the skin, mainly on the trunk. Cherry-shaped hemangiomas have no symptoms and are completely innocent lesions that are not associated with internal organ disorders. There is usually some kind of heredity in their appearance and they multiply in size and number with age. In some cases of trauma, the choroidal hemangiomas may bleed profusely and in such cases treatment should be immediate. The treatment of choroidal hemangiomas is mainly done for aesthetic reasons. However, there are cases that lead to their necessary removal. For example, if a large number of hemangiomas appear during pregnancy, they should be checked immediately.
- Asteroid hemangioma or Spider Vein: These are small blood vessels that take the form of spider webs, look like red or blue lines and are mainly found on the face, chest and upper limbs most commonly in women. It has been shown that almost one in two Greek women have spider veins on some part of their body. They are often referred to as “telangiectasias” and are easily visible to the naked eye. Hemangiomas that appear on the extremities are easier to treat than those that appear on the face. They often appear during pregnancy, when taking contraceptives, but they are also concomitant signs of other conditions such as liver failure. Heredity plays an important role in the appearance of spider veins, as it is responsible for 70% of cases. Often, however, they can occur after systematic use of corticosteroids, following hormonal changes, for example during puberty or pregnancy.
Quite a determining factor for the appearance of goiter in people with a genetic predisposition is prolonged standing, long hours of sitting, as well as excess weight or lack of exercise. In the lower limbs, varicose veins are often the result of venous insufficiency and are often combined with the presence of varicose veins. Varicose veins are a sign of poor blood circulation.
There are cases where the hemangiomas are not in obvious places, so that they are not detected until during another, random examination. This is particularly true in the case of a hemangioma in the liver. The vast majority of hemangiomas of this type do not show any symptoms, but this should not be a cause for concern, because in most cases they do not require removal and are completely harmless.
In many cases, the appearance of hemangiomas may even resemble that of skin cancer. However, they should never be confused, as skin cancer is a malignant tumor, while hemangiomas are benign and relatively harmless.
How many sessions are required for effective treatment of hemangiomas?
The number of sessions depends on the extent, depth of the lesion and the age of the patient. Most resistant to treatments are hemangiomas that are mainly located in the facial area. Usually, 7-9 sessions are required at least 1 month apart.
Is anesthesia required to treat hemangiomas?
Laser treatments are basically painless and the patient only feels a slight sting. However, in cases of extensive hemangioma in the facial area, local anesthesia is recommended.
Is recovery time required?
No hospitalization or recovery time is required, as the patient can return to daily activities immediately.
Is it safe to use Laser as a treatment for young children?
Pulsed Dye Laser treatment is indicated for young children and is quite effective as it requires a smaller number of sessions. In fact, it is even better to start the treatment at a young age, when the skin is thinner and there is not a large extent of hemangioma, so that almost 100% removal of hemangioma can be achieved.
The main advantages of Laser treatment are that it leaves no scars, particularly important as it does not allow foreign substances to enter the body. It is also extremely painless, as no local anesthesia or other analgesic is required. In addition, the individual can immediately return to daily activities without any side effects or pain.
Why should I choose Cosmetic Derma Medicine for the removal of hemangiomas?
Cosmetic Derma Medicine Medical Group is the largest and most specialized medical group in the field of Dermatology and Plastic Surgery, with 16 clinics in Greece and Cyprus.At Cosmetic Derma Medicine, we have the most complete range of lasers for hemangioma removal, with the main ones being the ND-YAG Laser, the Q Switched ND-YAG Laser, the CO2 Laser and the Pulsed Dye Laser.
The Dermatologists staffing Cosmetic Derma Medicine have been trained in Dermoscopy and Mapping at Universities in Greece and abroad. The Scientific Director of Cosmetic Derma Medicine is the Dermatologist – Venereologist Dr. Amalia Tsiatoura, while the staff consists of a medical team of highly experienced and specialized doctors of many different specialties, as well as a fully trained team of nurses. Our team is at your side every day, 24/7 for whatever you need.