Observation
Most hemangiomas don’t need medicine or surgery, but they should still be watched carefully, especially when a baby is very young. Hemangiomas grow the fastest in the first few months of life. During this time, doctors need to check them often to make sure they aren’t growing too quickly or causing problems.
Medications
Doctors often use oral steroids to treat hemangiomas called oral systemic corticosteroids. The steroids help stop the hemangioma from growing but usually don’t make it shrink. They are only given during the time when the hemangioma is growing.
Doctors can also inject corticosteroids directly into a hemangioma to treat small, localized skin hemangiomas. Another option is using steroid creams, which have recently been shown to help slow down the growth of small, surface-level hemangiomas, especially those on the eyelid or around the mouth.
Vincristine is a medicine used to treat tumors, but now doctors use it for hemangiomas that might cause serious problems, like vision loss or trouble breathing.
Propranolol is a medicine that has been used for a long time to treat high blood pressure. Recently, doctors found that it can also help treat hemangiomas. However, it must be used carefully because it can lower blood sugar if a baby doesn’t eat often and it can also lower blood pressure and heart rate. Babies taking this medicine need close monitoring.
Regranex gel is a medicine that helps heal ulcerated hemangiomas. It contains a special growth factor that helps the skin heal faster than regular wound care alone.
Surgery
Surgery is mostly used to fix scars or remove leftover tissue from a hemangioma. In some cases, early surgery might be the best choice, especially if the hemangioma is very likely to leave a lasting problem or if it puts a child's life or health at risk and medicine doesn’t work well. When there are no serious medical issues, doctors and parents have to think carefully about whether surgery is the right option because the scar from surgery might be worse than letting the hemangioma shrink on its own. Around age 4, doctors usually check how much of the hemangioma is still there and decide if surgery is needed, especially if it is causing scarring or shrinking too slowly.
Laser Therapy
Laser therapy can be used to treat hemangiomas, but different types of lasers work in different ways. A flash-lamp pulsed dye laser is good for treating small, surface-level hemangiomas and can help heal ulcerated ones, reducing pain and speeding up recovery. However, it doesn’t work well on deeper or thicker hemangiomas.
Other lasers, like Argon and Neodymium lasers, have been used too, but they need careful handling and can cause more scarring.
For very serious hemangiomas that don’t respond to steroid treatment, doctors may use interferon-alpha, a medicine that slows down new blood vessel growth. While it can be effective, it has side effects like irritability, low white blood cell count, and liver problems. A serious side effect called spastic diplegia, which affects movement, has been found in some patients, so this treatment is only used for life-threatening cases, and doctors closely monitor the patient’s neurological health.
In rare cases, a procedure called embolization is used to treat hemangiomas that don’t respond to other treatments. This method blocks blood flow to the hemangioma to stop its growth.
