Most lesions follow a predictable, benign clinical course. Initially, they grow rapidly for several weeks, then stay stable for several months and finally over the years they resolve, often resulting in an area of fibrosis, atrophic scarring, depigmentation or excess skin. Approximately 50% of lesions resolve before the age of 5 years and 70% before the age of 7 years.
Lesions that do not show signs of involution until the age of 6 years usually do not resolve completely. The overlying epidermis of the hemangiomas can be ulcerated resulting in bleeding.
Depending on their location, in the fast-growing phase, can exert pressure on vital anatomical structures (eyelids, external acoustic duct, and airway), causing amblyopia, strabismus, disorder of normal speech development, feeding problems and airway problems. In these cases, they should be urgently treated surgically.
Lesions that have a rapid growth rate in the proliferation phase, can be treated with β-adrenergic inhibitors, corticosteroids, interferon-α and laser. On the contrary, hemangiomas that follow a benign course and do not threaten vital structures are kept to resolve on their own. Parents’ complacency, patience and regular monitoring are required.
Some degree of atrophy and scarring is usually observed in the skin or a small residual lesion remains, in the end of the clinical course of hemangiomas. The treatment of these conditions is done by surgical removal, for aesthetic reasons.