What Is Infantile Hemangioma (Strawberry Birthmark)?

Medically Reviewed by Poonam Sachdev on March 16, 2023
4 min read

Infantile hemangiomas are birthmarks that grow on your baby’s skin after birth. Some are called strawberry birthmarks because they're bright red and bumpy.

A strawberry birthmark is called an infantile hemangioma. It's a bumpy red or purple patch on your baby’s skin and is made of a cluster of blood vessels. ‌

A hemangioma shows up soon after birth. As your baby grows, the blood vessels in the birthmark get growth signals, which causes them to quickly get bigger. The growth usually happens in the first 5 months after birth and is called the proliferative stage. By 3 months of age, your baby’s hemangioma will be about 80% of its final size. ‌

There are different types of hemangiomas:

Superficial. This type is in the surface layers of the skin and is the most common type of hemangioma. It is bright red and sometimes called a strawberry birthmark or strawberry hemangioma because the surface looks like a strawberry.

Deep. A deep infantile hemangioma affects deeper layers of the skin. These are usually smooth on the surface and look blue or skin-colored.

Mixed. The mixed type is in both surface layers and deeper layers of the skin. 

Extracutaneous. These are hemangiomas that grow on organs, bone, or in muscles. ‌

Hemangiomas can be different sizes and colors and show up in different places. They're usually not cancer.

It’s not fully clear why babies get hemangiomas. Some theories suggest it’s an inherited condition caused by certain genetic traits.

Other theories suggest proteins develop in the placenta that cause cells to grow quickly. At birth, these cells are spread apart, but over time they come together and make channels under the skin with blood cells. Growth signals cause them to grow into patches. 

Some babies have hemangiomas on the inside of their bodies, too. These aren't as common, but they can grow on the:‌

  • Thymus
  • Liver
  • Gallbladder
  • Spleen
  • Adrenal glands
  • Lungs
  • Pancreas
  • Digestive tract

Hemangiomas are more common in girls, twins, premature babies, and babies who have a low birth weight.

Hemangiomas in the skin are visible. Signs of an infantile hemangioma include:

  • Raised, bumpy patch
  • Shows up soon after birth
  • Looks red on light and dark skin
  • Looks blue
  • Grows quickly in the first few months
  • Sometimes has a sore
  • Sometimes bleeds‌

Strawberry birthmarks are on top of the skin, but some hemangiomas are under the skin. Hemangiomas that are near the eyes, ears, or nose can cause problems as they grow, like blocking airways or impairing eyesight.‌ Some are more purple or brown (like a bruise), especially on darker skin.

Most hemangiomas grow on the head and face, but your baby can have them anywhere. 

Your doctor will diagnose a hemangioma by examining it. Tests aren’t always needed. Depending on where the hemangioma is, your doctor may do tests to decide if it will cause problems with breathing, eating, or vision.

In these cases, your baby might have an ultrasound to see under the skin. If the patch is large, your doctor might do a magnetic resonance imaging, or MRI, to see if the growth is affecting any other important structures.

Treatment for a hemangioma depends on its size, location, and type. Most hemangiomas go away on their own and don’t need treatment.

There are times the hemangioma will need to be treated. These include if:‌

  • It grows near the nose, eyes, or mouth and begins to cause problems or interferes with vital functions
  • The skin starts to break down
  • Sores develop on the skin
  • It’s very large and will cause problems with growth
  • It’s on an internal organ and causes problems
  • It hurts‌

There are different treatment options, including:

Beta-blockers. These medications help lower blood flow to the strawberry birthmark. This will slow down growth and might turn it a lighter color. These can include propranolol medication and timolol gel. Beta-blockers can cause side effects like wheezing, high blood sugar, and low blood pressure.

Corticosteroids. Steroid medications can also slow down growth in the hemangioma. These are best used in the earlier growth stages. Once the birthmark reaches its peak size, steroids don’t seem to have as much effect. Steroids can lead to side effects like poor growth and thinning of the skin.

Interferons. These medications take a little longer to work and are only used if beta-blockers and corticosteroids don’t work.

Laser therapy. Your doctor will apply heat and light to the hemangioma to make it smaller and lighter in color. It works best when your baby is between 6 months and 1 year of age.

Surgery. Sometimes your doctor might recommend surgery, but this will depend on where it is. Strawberry birthmark removal can cause scarring. 

Surgery can cause damage to other tissues. It's usually only recommended for small hemangiomas or in places where they might cause problems with growth, or with important functions like breathing. Your doctor might wait until your baby is between the ages of 3 and 5 years to do surgery.

The outlook for most hemangiomas is very good. Most babies don’t need treatment because the hemangioma goes away on its own. By age 10, it usually fully disappears. ‌

It’s best to have your baby’s strawberry birthmark looked at as soon as possible. This can help with early treatment if it’s needed and prevent problems.