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Capillary Hemangioma

Disease Details

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Description: A capillary hemangioma is a benign vascular tumor composed of an abnormal overgrowth of tiny blood vessels typically occurring in infants and often resolving spontaneously over time.
Type: Capillary hemangioma is a benign vascular tumor of the capillaries. It does not have a known genetic transmission pattern and often occurs sporadically without a clear hereditary component.
Signs And Symptoms: Infantile hemangiomas typically develop in the first few weeks or months of life. They are more common in Caucasians, in premature children whose birth weight is less than 3 pounds (1.4 kg), in females, and in twin births. Early lesions may resemble a red scratch or patch, a white patch, or a bruise. The majority occur on the head and neck, but they can occur almost anywhere. The appearance and color of the IH depend on its location and depth within the level of the skin.Superficial IHs are situated higher in the skin and have a bright red, erythematous to reddish-purple appearance. Superficial lesions can be flat and telangiectatic, composed of a macule or patch of small, varied branching, capillary blood vessels. They can also be raised and elevated from the skin, forming papules and confluent bright-red plaques like raised islands. Infantile hemangiomas have historically been referred to as “strawberry marks" or "strawberry hemangiomas” in the past, as raised superficial hemangiomas can look like the side of a strawberry without seeds, and this remains a common lay term.Superficial IHs in certain locations, such as the posterior scalp, neck folds, and groin/perianal areas, are at potential risk of ulceration. Ulcerated hemangiomas can present as black crusted papules or plaques, or painful erosions or ulcers. Ulcerations are prone to secondary bacterial infections, which can present with yellow crusting, drainage, pain, or odor. Ulcerations are also at risk for bleeding, particularly deep lesions or in areas of friction. Multiple superficial hemangiomas, more than five, can be associated with extracutaneous hemangiomas, the most common being a liver (hepatic) hemangioma, and these infants warrant ultrasound examination.Deep IHs present as poorly defined, bluish macules that can proliferate into papules, nodules, or larger tumors. Proliferating lesions are often compressible, but fairly firm. Many deep hemangiomas may have a few superficial capillaries visible evident over the primary deep component or surrounding venous prominence. Deep hemangiomas have a tendency to develop a little later than superficial hemangiomas, and may have longer and later proliferative phases, as well. Deep hemangiomas rarely ulcerate, but can cause issues depending on their location, size, and growth. Deep hemangiomas near sensitive structures can cause compression of softer surrounding structures during the proliferative phase, such as the external ear canal and the eyelid. Mixed hemangiomas are simply a combination of superficial and deep hemangiomas, and may not be evident for several months. Patients may have any combination of superficial, deep, or mixed IHs.
IHs are often classified as focal/localized, segmental, or indeterminate. Focal IHs appear localized to a specific location and appear to arise from a solitary spot. Segmental hemangiomas are larger, and appear to encompass a region of the body. Larger or segmental hemangiomas that span a large area can sometimes have underlying anomalies that may require investigation, especially when located on the face, sacrum, or pelvis.
Unless ulceration occurs, an IH does not tend to bleed and is not painful. Discomfort may arise if it is bulky and blocks a vital orifice.
Prognosis: In the involution phase, an IH finally begins to diminish in size. While IHs were previously thought to improve by about 10% each year, newer evidence suggests that maximal improvement and involution is typically reached by 3.5 years of age. Most IHs resolve by age 10, but in some patients, the hemangioma does not completely resolve. Residual redness may be noted and can be improved with laser therapy, most commonly PDL. Ablative fractional resurfacing may be considered for textural skin changes. Hemangiomas, especially those that have gotten very large during the growth phase, may leave behind stretched skin or fibrofatty tissue that may be disfiguring or require future surgical correction. Areas of prior ulceration may leave behind permanent scarring.
Additional long-term sequelae stem from the identification of extracutaneous manifestations in association with the IH. For example, a patient with a large facial hemangioma who is found to meet criteria for PHACE syndrome will require potentially ongoing neurologic, cardiac, and/or ophthalmologic monitoring. In cases of IHs that compromise of vital structures, symptoms may improve with involution of the hemangioma. For example, respiratory distress would improve with involution of a space-occupying IH involving the airway and high-output heart failure may lessen with involution of a hepatic hemangioma and ultimately treatment may be tapered or discontinued. In other cases, such as an untreated eyelid hemangioma, resultant amblyopia does not improve with involution of the cutaneous lesion. For these reasons, infants with infantile hemangiomas should be evaluated by an appropriate clinician during the early proliferative phase so that risk monitoring and treatment be individualized and outcomes can be optimized.
Onset: Capillary hemangiomas, also known as infantile hemangiomas, typically appear within the first few weeks of life.
Prevalence: The prevalence of capillary hemangioma is not precisely known, but it is a common condition, particularly in infants. Approximately 4-5% of children are born with or develop capillary hemangiomas within the first few weeks to months of life. It is more prevalent in premature infants and females. Most cases of capillary hemangiomas resolve spontaneously and do not require treatment.
Epidemiology: Capillary hemangiomas, also known as infantile hemangiomas, are common benign vascular tumors of infancy. They are most prevalent in newborns, typically appearing within the first few weeks of life. The incidence rate is approximately 4-5% of all infants. These tumors are more common in females than males, with a ratio of about 3:1. They are also more frequently observed in premature infants and those with low birth weight. While the exact etiology is unknown, risk factors include maternal age and certain prenatal conditions such as placenta previa and preeclampsia.
Intractability: Capillary hemangioma, also known as an infantile hemangioma or strawberry hemangioma, is generally not considered intractable. These benign vascular tumors commonly appear in infants and often undergo natural regression over time. In many cases, they do not require treatment as they tend to shrink and disappear on their own by the age of 5 to 10 years. However, in some situations where the hemangioma causes complications, such as obstruction of vision or breathing, medical treatment or surgical intervention may be necessary.
Disease Severity: Capillary hemangioma is generally a benign and common vascular tumor of infancy. It often appears as a red or purple lesion on the skin and typically grows rapidly for several months before eventually stabilizing and gradually involuting over several years. Most capillary hemangiomas do not cause significant problems and often resolve without intervention. However, in rare cases, they can be severe if they impair vital functions or are located in critical areas such as the eyes or airways.
Healthcare Professionals: Disease Ontology ID - DOID:2725
Pathophysiology: Capillary hemangioma, also known as an infantile hemangioma or strawberry nevus, is a benign vascular tumor commonly found in infants. The pathophysiology of capillary hemangioma involves abnormal proliferation of endothelial cells, which are the cells lining blood vessels. This leads to the formation of small, tightly packed capillaries.

The exact cause of hemangiomas is not well-understood, but they are believed to result from a combination of genetic and environmental factors. Hypoxia (low oxygen levels) in localized tissue areas might trigger the angiogenesis process, mediated by factors such as vascular endothelial growth factor (VEGF). This excessive angiogenesis leads to the formation of the characteristic red or purple lesions observed on the skin or other organs.

These lesions typically undergo a rapid growth phase within the first few months of life, followed by a plateau and then a slow involution phase, where the hemangioma gradually regresses. Most capillary hemangiomas resolve on their own without intervention by the age of 5 to 10 years.
Carrier Status: Capillary hemangioma, also known as an infantile hemangioma or strawberry nevus, is a benign vascular tumor that typically appears in infancy. It is not a genetic disorder, so there is no carrier status associated with it. It most commonly appears as a red or purple mark on the skin and usually resolves on its own without the need for treatment.
Mechanism: Capillary hemangioma, commonly known as a "strawberry mark," is a benign vascular tumor that is especially prevalent in infants and young children. It primarily consists of an overgrowth of capillary blood vessels.

### Mechanism:
Capillary hemangiomas typically arise from abnormal proliferation of endothelial cells, which are the cells lining blood vessels. The precise trigger for this abnormal growth remains unclear, but it is thought to involve disruptions in the regulatory mechanisms that normally balance angiogenesis (formation of new blood vessels) and apoptosis (programmed cell death).

### Molecular Mechanisms:
1. **VEGF (Vascular Endothelial Growth Factor):** VEGF and its receptors play a crucial role in the formation and growth of capillary hemangiomas. Increased expression of VEGF promotes the growth and proliferation of endothelial cells, contributing to excessive vascular formation.

2. **HIF-1α (Hypoxia-Inducible Factor 1-alpha):** This transcription factor is often upregulated in hypoxic conditions and can stimulate VEGF production, further enhancing angiogenesis in hemangiomas.

3. **Angiopoietins/Tie2 Pathway:** Angiopoietin-1 (Ang-1) and Angiopoietin-2 (Ang-2), along with their receptor Tie2, are important for vascular development and remodeling. Dysregulation of this pathway is implicated in the development of capillary hemangiomas.

4. **MMPs (Matrix Metalloproteinases):** These enzymes degrade the extracellular matrix and are involved in tissue remodeling. Increased activity of MMPs can contribute to the invasion and expansion of capillary hemangiomas.

5. **Genetic Factors:** Several genetic mutations and polymorphisms have been associated with the development of capillary hemangiomas, although a single causative genetic factor has not been definitively identified.

Overall, the development of capillary hemangiomas involves a complex interplay of molecular signals that regulate angiogenesis, endothelial cell proliferation, and tissue remodeling.
Treatment: Most IHs disappear without treatment, leaving minimal to no visible marks. This may take many years, however, and a proportion of lesions may require some form of therapy. Multidisciplinary clinical practice guidelines for the management of infantile hemangiomas were recently published. Indications for treatment include functional impairment (i.e. visual or feeding compromise), bleeding, potentially life-threatening complications (airway, cardiac, or hepatic disease), and risk of long-term or permanent disfigurement. Large IHs can leave visible skin changes secondary to significant stretching of the skin or alteration of surface texture. When they interfere with vision, breathing, or threaten significant disfigurement (most notably facial lesions, and in particular, nose and lips), they are usually treated. Medical therapies are most effective when used during the period of most significant hemangioma growth, which corresponds to the first 5 months of life. Ulcerated hemangiomas, a subset of lesions requiring therapy, are usually treated by addressing wound care, pain, and hemangioma growth.
Compassionate Use Treatment: Capillary hemangioma, also known as infantile hemangioma, is a common vascular tumor in infants. Treatments typically focus on managing symptoms or complications rather than complete removal. Compassionate use and off-label or experimental treatments may include:

1. **Propranolol**: Though primarily a beta-blocker for heart conditions, it's been found effective in reducing hemangioma size and is widely used off-label.

2. **Timolol**: A topical beta-blocker, originally for glaucoma, is also used off-label, especially for superficial hemangiomas.

3. **Corticosteroids**: Oral or injectable steroids, like prednisone, may be used but are less common now due to propranolol's effectiveness.

4. **Laser Therapy**: Pulsed dye laser treatment can be used experimentally to reduce the redness and size of hemangiomas.

These treatments are selected based on the hemangioma's size, location, and any complications it may cause.
Lifestyle Recommendations: For capillary hemangioma, which is a benign vascular tumor commonly known as a "strawberry mark," lifestyle recommendations generally focus on monitoring and managing the condition. These include:

1. **Regular Monitoring**: Routine check-ups with a healthcare provider to monitor the hemangioma for any changes in size, shape, or color.
2. **Skin Care**: Use gentle skin care products to avoid irritation around the hemangioma.
3. **Sun Protection**: Apply sunscreen to protect the area from sun exposure, which can cause complications.
4. **Avoid Trauma**: Be cautious to prevent any trauma or injury to the hemangioma, especially if it is raised or located in an area prone to friction.
5. **Healthy Diet**: Maintain a balanced diet to support overall skin health.
6. **Follow Medical Advice**: Adhere to any specific treatments or procedures recommended by healthcare professionals, such as laser therapy or medication if necessary.

Consult with a healthcare provider for individualized advice.
Medication: Treatment options for IHs include medical therapies (systemic, intralesional, and topical), surgery, and laser therapy. Prior to 2008, the mainstay of therapy for problematic hemangiomas was oral corticosteroids, which are effective and remain an option for patients in whom beta-blocker therapy is contraindicated or poorly tolerated. Following the serendipitous observation that propranolol, a nonselective beta blocker, is well tolerated and effective for treatment of hemangiomas, the agent was studied in a large, randomized, controlled trial and was approved by the U.S. Food and Drug Administration for this indication in 2014. Oral propranolol is more effective than placebo, observation without intervention, or oral corticosteroids. Propranolol has subsequently become the first-line systemic medical therapy for treatment of these lesions.Since that time, topical timolol maleate in addition to oral propranalol has become a common therapy for infantile hemangiomas. According to a 2018 Cochrane review, both of these therapies have demonstrated beneficial effects in terms of clearance of hemangiomas without an increase in harms. In addition, no difference was detected between these two agents and their ability to reduce hemangioma size; however, whether a difference in safety exists is not clear. All of these results were based on moderate- to low-quality evidence, thus further randomized, controlled trials with large populations of children are needed to further evaluate these therapies. This review concluded that for now, no evidence challenges oral propranalol as the standard systemic therapy for treatment of these lesions.
Other systemic therapies which may be effective for IH treatment include vincristine, interferon, and other agents with antiangiogenic properties. Vincristine, which requires central venous access for administration, is traditionally used as a chemotherapy agent, but has been demonstrated to have efficacy against hemangiomas and other childhood vascular tumors, such as kaposiform hemangioendothelioma and tufted angioma. Interferon-alpha 2a and 2b, given by subcutaneous injection, has shown efficacy against hemangiomas, but may result in spastic diplegia in up to 20% of treated children. These agents are rarely used now in the era of beta-blocker therapy.
Intralesional corticosteroid (usually triamcinolone) injection has been used for small, localized hemangiomas, where it has been demonstrated to be relatively safe and effective. Injection of upper eyelid hemangiomas is controversial, given the reported risk of retinal embolization, possibly related to high injection pressures. Topical timolol maleate, a nonselective beta blocker available in a gel-forming solution approved for the treatment of glaucoma, has been increasingly recognized as a safe and effective off-label alternative for treatment of small hemangiomas. It is generally applied two to three times daily.
Repurposable Drugs: Capillary hemangiomas, also known as infantile hemangiomas, are benign vascular tumors commonly seen in infants. While they often resolve on their own, treatment may be necessary for severe cases or those causing complications.

Repurposable drugs for treating capillary hemangiomas include:
1. **Propranolol**: A non-selective beta-blocker originally used for treating hypertension, now commonly used for infantile hemangiomas.
2. **Timolol**: A topical beta-blocker, used as a gel or solution, particularly for smaller or superficial hemangiomas.
3. **Corticosteroids**: Prednisolone, either oral or injectable, though less commonly used today due to the effectiveness of beta-blockers.
4. **Vincristine**: An older chemotherapeutic agent used when hemangiomas are refractory to other treatments, particularly in severe cases.

Please consult a healthcare provider for personalized medical advice.
Metabolites: Capillary hemangioma is a benign vascular tumor typically consisting of an abnormal overgrowth of capillary blood vessels. Information about specific metabolites directly associated with capillary hemangiomas is not well-documented. Research typically focuses on the molecular and genetic aspects rather than metabolomic profiling. If you need detailed metabolic information specific to capillary hemangioma, further specialized studies are required.
Nutraceuticals: There are no well-established nutraceuticals specifically for the treatment of capillary hemangioma. Management typically includes observation, medical therapy like beta-blockers (e.g., propranolol), or in some cases, laser therapy or surgery. Nutraceuticals are not part of the standard treatment protocol for this condition.
Peptides: Capillary hemangioma, also known as an infantile hemangioma or strawberry nevus, is a benign vascular tumor composed of an abnormal overgrowth of capillaries. It commonly appears in infants and usually undergoes spontaneous involution by the age of 7. While peptides are not specifically used in treating capillary hemangiomas, propranolol, a non-selective beta-blocker, is a well-established treatment. Prognosis is generally good, with many hemangiomas resolving naturally without significant interventions.