Strawberry naevus (forever?)

I’ll confess that I knew very little about haemangiomas before our little boy developed one. Infantile haemangiomas, more colloquially known as strawberry naevi if they appear on the skin’s surface, are a type birthmark that, although often not present at birth, develop in the first few weeks of a baby’s life. They normally start as a small bruise-like patch and can swell into a red blob, which gives rise to the name ‘strawberry’, and often reach their maximum size within the first year. They are benign and are rarely treated, instead being left to recede and eventually fade as the child gets past 3-4 years of age.

It’s interesting that they’re so common – approximately 10% of Caucasian babies have them (they’re less common in other ethnicities) – yet no one really knows what causes them. They are known to arise as a result of overgrowth of the cells surrounding blood vessels, and there are theories that this is due to high levels of oestrogen in the womb or to a tiny piece of placenta that lodges itself to the developing baby’s skin, but there is very little hard evidence for a cause. All we know for sure is the observed prevalence – they’re more common in girls by 3:1, and low birth weight or premature babies are more likely to develop one.

They can certainly be psychologically distressing for children, especially when they develop prominently on the face and take a long time to recede (see image search). They can also physically affect a child if it grows on or near their eye, nose or mouth – the majority of haemangiomas grow on the face or neck – and can consequently impair sight, breathing and eating. We are lucky in the sense that our boy’s growth is on the top of his head, away from any organs, and we hope that hair will grow to cover it.

Other parents whose child had a strawberry naevus are very keen to come up and point it out. Usually it’s for the comforting reassurance that their child’s growth faded by the time they were five years old. What is less welcome is people whose first offhand question is “what’s that thing on his head?” or “did you drop him?”.

It’s a common benign growth and, no, we didn’t.

Our little one’s started, as seems most common, as a red patch at around 4 weeks old and has grown over the next 3 months to around 2.5 cm across and protuding around 1 cm. After assuring ourselves that it was benign and not the result of an injury, we decided to take him to the dermatologist to double-check and get some more information from a health professional.

Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.

Reuben's 'strawberry' *

The dermatologist asserted that “10% are gone by 1 year and all are gone by age 10”. That was a relief to hear. But I was curious as to whether 100% of haemangiomas really are gone by the 10 years old and so did what any right-minded person would do: google.

This brought me across some interesting findings, even ignoring the usual sources of unsubstantiated claims and focussing on those with a little more validity. On average they disappear at a rate of 10% per year – 70% are gone by the age of 7, 80 % by age 8, and so on. However, it seems that after 90% have receded by the age of 9, the graph plateaus, leaving 10% of haemangiomas still present by age 10. That made me wonder whether the dermatologist simply extrapolated this trend to 100% by age 10.

According to the Office of National Statistics there were 807,257 registered births in the UK in 2010. Using the estimate of 5% prevalence, that means we can expect over 40,000 haemangiomas in that year. More than 36,000 of these growths will probably disappear (90%), which leaves approximately 4,000 of the 2010 babies with marks that will not completely disappear. At this stage, laser treatment or steroids are often used to reduce the size of growth or surgical removal may be needed.

These are clearly not trivial interventions (risk of blood loss, permanent scarring, etc.) and it would have, in my view, been incumbent on the dermatologist advising us that there was a chance, albeit slim, that we would be in this position. Instead, we received a casual assurance and were sent on our way.

* Creative Commons License

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10 thoughts on “Strawberry naevus (forever?)

  1. Pascal

    Thanks very much for these information. Our son is 10 months old and he also has a strawberry mark on his head, which did worry us until we spoke to our health visitor. She told us that this is very common and they are usually all gone by the age of 8. No stastistics here but because placed on the head, we did not seek further medical advice. To be frank, I never really thought about it apart that it was “lucky” it did not grow on his face. To see the pictures displayed on the link here makes me realise how bad it could have been and how lucky we are. Some pictures are shocking and so sad …..
    We also had few people asking “What’s this thing on his head ? Did he bang himself “…. it’s fine and ok. I don’t mind and I prefer people asking rather than avoiding to speak about it, in fear of “embarassing us”.
    Thanks for all these information. Very interesting and brilliant blog !

    Reply
    1. The Skeptical Dad Post author

      Thanks for the feedback, Pascal. I perhaps didn’t quite articulate it in the post that we too would prefer to tell people about it so that they understand it’s normal, and we always happy to do this. The issue is more when the initial question is abrupt and coming across as callous.

      I hope your little one’s mark doesn’t cause any problems and disappears over time (as in the majority of cases).

      Reply
  2. Lauren

    Hi Matt! I stumbled across your blog while trying to find some enlightenment on my daughter’s strawberry naevus and it was very refreshing to read. Nyasa is turning one next week and her “bump” is on her forehead, in her hairline. It is currently about 2.5cm across, 1cm high. I was convinced it had started to recede a few weeks ago, and then she smacked it open and now we are going through a series of bang-bleed-scab-bang-bleed-scab, and I am starting to lose the plot a bit! I had heard or propranolol being used to reduce them faster, but had understood that it was only just finishing going through trials and was not yet available. Last night I was maddened to read that it has already been used extensively in the US and UK to treat SN’s but that it has to be given before 5 months of age, while it is still in its aggressive growth stage. I am now not sure what step is next, as it is not really a danger to her, but it is now hurting whenever she knocks it and I think she will develop a scar one way or the other with all the scabbing and banging. We live in Malawi, 400km from the nearest hospital I would trust, and even then I don’t think they have any proper dermatology units. I am going home to South Africa in a month’s time and will be consulting a paediatric dermatologist there.
    My main reason for writing here wasn’t actually to tell you Nyasa’s whole story, but to find out how Reuben’s has progressed. I am getting tired of hearing “it will go away” and would love to hear how you’ve moved along!
    Hope to chat soon 🙂
    Lauren

    Reply
    1. The Skeptical Dad Post author

      Hi Lauren,

      Thanks for writing and sorry it’s taken me so long to reply. I’m sorry to hear that Nyasa bumped her naevus – I hope she’s on the mend now. We’ve fortunately avoided Reuben bumping his, so don’t have any experience of that. The diameter of his naevus hasn’t really reduced, but it doesn’t stick up as much as it did – it was about 1cm high, but is now raised by only a couple of millimetres. His hair is also thicker now so that covers it (if we comb it the right way!).

      I hope Nyasa’s starts to fade soon. As I said in my post, the stats I read said that around 10%, on average, disappear each year – so around 10% have gone by the 1st year, so I guess it’s not unusual for it not to have gone the first birthday. As for Propranolol treatment, it is used in the UK but mostly for large or complicated birthmarks (e.g. if it’s blocking an airway or sense organ), as most go without treatment (so you can avoid any risk of side effects (http://www.nhs.uk/Conditions/Birthmarks/Pages/Treatment.aspx / http://www.gosh.nhs.uk/medical-conditions/search-for-medical-conditions/haemangioma/haemangioma-information/). But I’m not a doctor so speaking with a paediatric dermatologist is definitely the best thing to do if you’re concerned.

      Hope it goes well and let me know what the dermatologist says!

      Matt

      Reply
      1. Lauren

        Hi Matt! Thanks for your reply – I have taken ages to get back to you because we were getting married/honeymooning/getting back to real life.
        I wanted to let you – and anybody else who reads this blog – know of the little bit of wondrous medicine we discovered while in SA. My aunt recommended that we go to a plastic surgeon who she knew had dealt with haemangiomas before. What the doc told us made us very happy, and very irritated at the same time. Irritated because nobody had ever mentioned this to us! We were told about Bleomycin injections. Very basically, this is injected directly into and around the naevus, and anywhere from 1 to 4 injections are required to see little strawberry on its way. These injections would normally be spaced a month apart. Nyasa had her first on 12/12/12 and when we saw her after our honeymoon, at then end of January, we were blown away! Her “bump” had reduced to a quarter of its size. We went for a checkup and the doc said it would need only one more shot. She had that on 13 February (2 months later, but timing made no difference), and her bump has reduced by another half of its new size! It was a relatively inexpensive process and Nyasa had to undergo general anaesthetic, and the procedure itself took about 15 minutes. Once the anaesthetic wore off, Nyasa was back to her normal self – so within half an hour after coming out of surgery. It has made such a difference in her life, and ours, to not have to worry about hitting her bump. People who saw her when we returned from SA after nearly 3 months were completely flabbergasted by how her bump has almost disappeared.
        Anyway, just thought I’d share that – we were so happy to find a solution and I hope someone else will benefit as well, should they read this.
        Happy days!
        Lauren

        Reply
  3. Lily

    Hi, I have one of these marks on my cheek, its smallish and has faded about 70%. I’m now fifteen years old and still waiting for it to disappear. It seems I am the one percent. It’s not really an issue anymore for me since I just put makeup over it. I’m sure your son will have better luck than me though 🙂

    Reply
    1. The Skeptical Dad Post author

      Thanks for the message Lily. I’m glad to hear it’s not really an issue for you. Reuben’s is covered by his hair and is almost flat – it seems to be fading in colour too. He does still have a purplish mark on the corner of his mouth, which hasn’t faded so we’ll see whether that develops.

      Our main worry was when we were told that having a couple of external ones increased the chance of having an internal one (although one doctor never told us this and it was only picked up later by a second doctor – grrr). Reuben had to have an ultrasound scan to make sure there wasn’t one on his one of his organs – thankfully it was clear. I guess doctors need to more of this because it could have been missed altogether.

      Reply
  4. Sarah

    Hello. I’ve ended up on this blog after googling to see if hair ever grows back fully through an old naevus, so I’ll add my story:

    Daphne developed her naevus about a week after she was born. It was in almost exactly the same place as Reuben’s, perhaps a little further back, started off like a raisin and grew to be a bit bigger than a 50p piece and raised by a few mm. I can’t now remember when it started to go, 2ish probably. She’s now almost 5 and it’s completely flat and silvery with a few pale pinky purply bits but not really noticeable at all unless you’re really looking. There’s less hair growing through it, I’m hoping more will come but it’s by no means bald, just thinner.

    The original post made me chuckle as “What’s that thing on her head?” is EXACTLY what people used to say to us (so much so that my partner had a little joke where he would go “Roll up, roll up, see the girl with the thing on her head”). It never bothered us either as she was blessed with the biggest and most beautiful eyes and we got far more comments on those!

    Reply
  5. Eve Sacks

    My son is 3.5 and has one on his chest, about an inch above nipple. Around 1-1.5cm across and raised but not raised by much. Appeared after birth, (at term) although there was a mark at birth, just got bigger in first few months. He also had a small one on a toe (now gone) and a small one on bottom (faded signifantly). The one on his chest shows no sign of receding, but because its on his chest (ie normally covered up) it doesn’t bother him, he calls it his red spot. I hope it will fade a bit, older son had another sort of red mark (flat) on his abdomen (can’t remember what it was called), and at 7 has almost totally faded. But ultimately, I just think he was lucky, as its on a part of his body normally covered up, and I think that its less of a big deal if it doesn’t fade completely for boy than for a girl.

    Reply
  6. ashkat21

    Hi there! Just thought I’d input my statistics from a “childs” perspective. I’m 19 years old and I actually still have my strawberry mark on my scalp. It’s never faded in red color or made any signs that it’s going away. It’s never really been a problem, but I’m starting to get worried now because I can’t find anything about people who continue to have them after the 10 year mark. It’s not visible to the public or anything because my hair hides it (although no hair grows specifically in that spot). The only people who mention it are the people at hair salons when they’re cutting my hair and happen to see it. I also feel like it could be the cause of my headaches every now and then, but I think I’ll get it checked out by a doctor soon. Anyway, thanks for your blog!

    Reply

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