Capillary Haemangioma

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Clinical Presentation

  • Not visible at birth, only becomes apparent after days to weeks
  • Growth during the first 6-9 months of life, followed by slow regression over several years (completed in 80-90% after 4 years, depending on size)
  • Superficial lesions are bright red (strawberry naevus), deeper ones are bluish/violet
    • Can be pressed away with a glass spatula (in contrast to port-wine stain)
  • In cases of eyelid/orbital involvement: risk of amblyopia due to ptosis or pressure on the eyeball (anisometropia/astigmatism)
  • Exophthalmos possible, increased when crying
  • Associations
    • PHACES Syndrome: Posterior fossa malformations, haemangioma over 5 cm on the head and neck, arterial anomalies, cardiac anomalies (e.g. coarctation of the aorta), eye anomalies, sternal or abdominal clefting or ectopia cordis
    • Kasabach–Merritt Syndrome: multiple haemangiomas with visceral involvement, can lead to thrombocytopenia, high mortality


  • Refraction: Anisometropia/Astigmatism?
  • Pediatric examination: systemic/extracutaneous involvement?
  • Photodocumentation
  • Ultrasound: documentation of size, depth
  • MRI/CT: extent?
    • Not necessarily required for small findings with classic history and clinic

Differential Diagnoses

  • Vascular malformation: possible from birth, slow growth over decades, no spontaneous regression
  • Port-wine stain / Naevus flammeus
  • (Orbital) tumors


  • Oral propranolol (CH: Hemangiol solution 3.75 mg/ml) for at least 6 months (usually prescribed by a pediatrician)
    • Caution: EKG before starting therapy
  • Topical therapy with Timolol gel 0.5% (magistral medicine)
  • Others: Steroid therapy (oral/topical), laser, excision, interferon therapy
  • in case of risk of amblyopia: close orthoptic monitoring