Early Signs of Hemangioma? Please advise.

[oprichard]

My wife and I gave birth to a beautiful daughter about 2 1/2 weeks ago.

About a week or so after birth, we noticed a bluish tint on the tip of her nose and nasal septum. We didn't think much of it, until the pediatrician noticed it and said it might be a bruise. That didn't make sense to me and now I think this is probably a hemangioma. Also, she has some reddish marks on her stomach (not raised).

Her big sister, 18 months old, has been undergoing laser treatment for a facial PWS for most of her life, so we are pretty attuned to birthmarks.

We are taking the baby in to see the derm next week, when our older daughter is scheduled for PDL treatment.

A couple of questions:

1.) What do hemangiomas usually look like in the early days? Are they bluish like this?

2.) If so, does that mean it is more likely a cavernous H rather than a strawberry H? Or do strawberry (superfical) H's usually look like this in the beginning as well?

3.) Are there differences in progression (growth), resolution (involution), and treatment options for a cavernous versus a superficial H?

4.) Would a derm recommend treatment for a child as early as a few weeks? If so, what type?

[jgoodman0814]

my houngest daughters hemangioma was also called a bruise when she was born. it was almost not even noticable at birth, becoming more red after about 4-6 weeks and being raised at about 6 weeks on. there are also hemangiomas that dont turn red all the way depending on how deep they are. i have seen them bluish/purplish. my oldest daughter has a large blue spot that runs across the top of the bridge of her nose, in between her eyes. shes 7 now and its still blue as can be especially when shes sick or upset. everyone always asked me if she hit her nose on something. the dr always told me that it was just a vein, that it would go away eventually. 7 years later.....its still there and really never thought about it being a hemangioma until now. my advise is to just keep an eye on it. they wont really know if its a hemangioma until it starts to turn or grow. my youngest daughters website is www.caringbridge.org/visit/avaball if you would like to talk more, email me there or here. good luck!

[nickbar]

Congrats on your new baby.
Deep hemangiomas will appear bluish. (cavernous). Strawberry h. typically appear looking pinkish. Laser typically wil not work on a deep hemangioma. All h. are different with growth and involution, but deep h. tend to be a bit more stubborn for involution. Based on the location it is important to document changes and how rapidly the growth is. I would seek advice from an experienced specialist on what options you have for controling the growth. I have heard of doctors treating these early (especially in the nasal region) to control growth right away. You'll probably get the wait and see as it is often the way h. are handled. I do know of cases where the derm. was called into NICU or Nurseries after delivery to give steroid injection and the h. never developed further. There are some risks with steroid injections and must be done by an experienced physician. I encourage you to seek multiple opinions. If you need any help locating specialist, let me know.

Good luck and keep us posted.

[AubrieB]

My son was born with with 3 visible hemangiomas and the 4th, on his nose, didn't show up until around week 4. It looked like a bruise and continued to get more noticeable. Here is a pic after one PDL treatment. (1st pic) The other is before treatment. He is scheduled to have 3 removed on Oct 21st with Dr Buckmiller at Arkansas Childrens Hospital.

[oprichard]

Thanks for your responses, everyone. It is wonderful to have so many experts out there, both to collect valuable information and also to know we're not the only parents to have confronted this challenge. Our older daughter was born with a PWS; they ought to give us an honorary degree in vascular lesions for all this trouble!

So a couple more questions:

We are going to see two specialists in nyc next week (Bernstein, who is doing a wonderful job treating our older daughter with PDL, and then Levitin, who works with Dr. Waner).

Our duaghter is still only 3 weeks old, so lots of unknowns out there in terms of how this thing develops, BUT....if this is, in fact, a deep H (although it may be compound b/c there is MAYBE a red tinge poking through) on her nasal tip/septum, is there any chance Bernstein will want to use the PDL on the first visit?

The reason I ask is, as Corrine points out, they often say that deep H's don't respond well to laser...Is that always the case? Do the cutting edge (no pun intended) laser dermatologists see any value in treating deep H's early with laser, as they do with port wine stains?

Aubrie, the H on your son's nose (he is adorable) appears to be a compound one. Was the PDL used on his nose? If so, was that to treat/shrink the blue swelling or to treat the sperficial/red portion of the mark?

Thanks again everyone!