What Is Strawberry Birthmark? Symptoms, Causes & Treatment

They often fade on their own and require treatment only in rare cases.

Medically reviewed by Dr. Dur Afshar Agha, MS Dr. Dur Afshar Agha Dr. Dur Afshar AghaMS facebook_iconinsta_icon Specialty: Masters of Tropical PediatricsExperience: 26 years
Written by Dr Bisny T. Joseph Dr Bisny T. Joseph
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They often fade on their own and require treatment only in rare cases.

Strawberry nevus, commonly known as strawberry birthmarks, is an infantile hemangioma that presents as a clump of additional blood vessels under the skin. Abnormal blood vessels cause this benign (noncancerous) growth. Hemangiomas may vary in size, location, and appearance. It can be present at birth or emerge a few weeks or months later, and it normally fades away before the child turns five.

Although the presence of hemangiomas can be alarming, they fade away without complications or treatment in most newborns. However, large hemangiomas may necessitate treatment to avoid irreversible scarring.

Read on to learn about the different types of infantile hemangiomas and their causes, symptoms, complications, and treatment options.

Types Of Infantile Hemangiomas

Infantile hemangiomas can be of the following types (1).

  • Superficial hemangiomas or capillary hemangiomas: It is also known as strawberry marks since the appearance may resemble a strawberry. These bright red, raised lesions usually begin as small pink, white, or red areas on the skin. Strawberry marks can be in one spot or over a large area.
  • Deep hemangiomas or cavernous hemangiomas: This hemangioma forms under the skin, and the surface can be smooth. You may notice a bluish tint and swelling in the skin.
  • Mixed hemangiomas: This is a combination of deep and superficial hemangiomas.

Causes Of Infantile Hemangiomas

The exact cause for infantile hemangioma is not known. It could occur due to the grouping of extra blood vessels for unknown reasons. Premature babies are more likely to get hemangiomas than term babies (2).

Some studies state that specific placental proteins in pregnancy may induce strawberry birthmark formation. However, this theory also lacks enough scientific evidence. Female gender and the presence of certain genes may be risk factors for developing strawberry marks.

Symptoms And Signs Of Infantile Hemangiomas

Hemangiomas may be present at birth or appear during the initial months of life. You may notice flat red or pink spots on the skin, and they may grow quickly into spongy bumps that stick out of the skin surface (3).

Strawberry birthmarks can occur anywhere on the body. However, it is more likely seen on the face, chest, scalp, and back of the body. Most babies may have a single strawberry nevus, while a few can have several of them.

Once the growth is finished, the hemangioma may stay in the same size or slowly begin to disappear by five to ten years of age. Hemangiomas may become less reddish and fade to grey or white when it starts to resolve. They may shrink or flatten from the center to the outside. Skin can be slightly discolored or raised even after the birthmark goes away.

Complications Of Infantile Hemangiomas

Hemangioma may break down and develop an open sore (ulcer) in some babies. This may cause the following complications (3).

  • Pain
  • Infection
  • Bleeding
  • Scarring
  • Permanent skin changes and distorted nose or facial part may occur in cases of large hemangiomas on the face

Hemangiomas may interfere with the body’s normal functions, depending on its location, and may cause the following complications.

  • Vision problems, such as lazy eye (amblyopia) and glaucoma
  • Hearing problems if located in the ear
  • Breathing and eating difficulties are seen in larger hemangiomas located in the mouth
  • Bowel movements can be affected if the nevus is located in the anal area

Although rare, vision loss may occur due to optic nerve atrophy if the hemangioma is located in the eye socket and presses the optic nerve.

Diagnosis Of Infantile Hemangiomas

Pediatricians can diagnose strawberry nevus on the skin by visual examination. Pediatricians may evaluate the size, number, and location of hemangiomas to plan treatment options. Referral to an ophthalmologist, pediatric dermatologist, or otorhinolaryngologist (ENT) is made depending on the site of hemangioma (4).

Specific tests are not necessary to diagnose strawberry birthmarks. Rarely, if the hemangiomas are located inside the body, imaging tests may be needed to monitor its growth.

Treatment For Infantile Hemangiomas

Treatment options may vary depending on the severity, size, and location of the strawberry birthmark. Although most of the hemangiomas on the skin may not require treatment, hemangiomas in the eye could need treatment to avoid vision problems.

The available treatments for strawberry birthmarks may include the following (5).

1. Systemic treatments

Systemic treatment involves the intake of oral or intravenous medications to control hemangiomas. Treatments may continue until the first year of life in some babies to avoid the recurrence. This may include:

  • Oral steroids: This is a safe and effective oral medication for hemangiomas used in some babies.
  • Propranolol: This is a beta-blocker medication that is prescribed for complicated hemangiomas. Oral intake is recommended, and the baby is observed for possible side effects since this may affect cardiac functions and blood pressure.

2. Localized treatments

Localized treatments are often prescribed for most babies. This may include:

  • Steroid injection: This is the preferred treatment method for small and localized hemangiomas. The injection is given to the strawberry birthmark to reduce its growth.
  • Topical medications: These medications are applied directly to superficial or capillary hemangioma Creams and ointment, including beta-blockers, are the best effective topical medications for strawberry nevus. This could cause the shrinking and fading of the birthmark.
  • Steroid creams: Topical steroid creams are prescribed for thin and small hemangiomas.

All the systemic and localized medication for strawberry birthmarks require a medical prescription. It is not recommended to use over-the-counter medications to treat hemangiomas in babies.

3. Other treatments

Hemangiomas may also require procedures and surgeries other than medical treatments. This may include:

  • Surgery: Small hemangiomas located on areas that may result in complications, such as vision problems, are surgically treated. Surgery may leave a scar or extra skin, and this is usually repaired when the baby is between three or five years of age.
  • Laser treatment: This may reduce bleeding and enhance the healing of strawberry birthmarks with open sores. Skin color and texture changes are also treated with laser after the hemangioma goes away. This may also help to lighten the color of hemangioma and make it less visible.

These treatments are delayed in most babies with uncomplicated strawberry birthmarks since they may fade away without leaving any scars.

How to Cope When Other People Stare?

Some parents may face hard times dealing with others’ reactions to strawberry birthmarks on visible areas such as on the face, neck, arms, and ears. Although someone’s comment or stares at your baby can be difficult, you may try these tips to deal with such situations.

  • Learn about hemangioma and its treatment options. It can help you better communicate about it to others.
  • Explain that this is a condition that resolves over time if someone asks or suggests remedies to cure it.
  • Understand that someone can be curious to know about the skin lesion and not trying to be rude to you.
  • Smile or wave at people who stare unusually. This may make them embarrassed and take their eyes off your baby.
  • Say hello and take the opportunity to educate them about hemangiomas if they ask you about it.
  • Ignore people who stare rudely at your baby. They have nothing to do with your life.
  • Never let it get you. This is a normal condition that resolves over time. You should not avoid going out and having precious time with your baby to avoid others’’ questions or stares.
  • Seek support from family, friends, or a support group if it disturbs you. Never spoil your emotional wellbeing for it.

You may also understand that the hemangioma resolves itself within a few years. Rushing to treatment options to avoid embarrassment or stare is not an ideal decision. You may seek pediatric consultation to know the requirement of treatment.

Frequently Asked Questions

1. How long do strawberry birthmarks last?

Most strawberry birthmarks shrink and flatten when the baby turns four to five years of age (5). However, for some, the marks could be there for many years.

2. When should I worry about a strawberry birthmark?

You should be concerned about a strawberry birthmark if it bleeds, itches, causes pain, or shows symptoms of infection (6).

3. Do all strawberry birthmarks grow?

Most strawberry birthmarks grow. They usually grow fast in the first two to three months after birth, growth slows by three to four months, remains constant thereafter and then begins to shrink and fade by the time the child is about 12 months old (7).

A strawberry birthmark or a superficial hemangioma occurs due to the clumping of blood vessels under the skin, resolving as the baby grows older. They appear as red spongy bumps over the face, scalp, back, or chest. It is mostly seen in female babies, and genetic factors may be responsible. However, some babies may develop complications such as infection or scarring, especially if the hemangioma covers a large area. Doctors may suggest using creams, medications, or laser treatment depending on the severity of the condition. Surgery may be required in a few complicated cases.

Key Pointers

  • Strawberry birthmark or infantile hemangioma may occur anywhere on the body.
  • Although they fade on their own in a few years, sometimes these birthmarks could cause vision troubles, scarring, or an infection.
  • A dermatologist diagnoses these moles by a physical examination.
  • The treatment may include steroids pills, creams, or injection and surgery.

References

1. Infantile Hemangioma; Johns Hopkins Medicine
2. Infantile Hemangioma: Definition and Pathogenesis; DermNet NZ
3. Infantile Hemangioma; UCSF Benioff Children’s Hospitals
4. Diagnosis and Management of Infantile Hemangioma; The American Academy of Pediatrics
5. Infantile Hemangiomas: About Strawberry Birthmarks; Healthychildren; The American Academy of Pediatrics
6. Medline Plus; Medline Plus
7. Hemangioma; Nationwide Children’s Hospital
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Dr. Dur Afshar Agha
Dr. Dur Afshar AghaMS
Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha
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