A new treatment for strawberry birthmarks

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Treatments with dramatic effects are occasionally discovered by accident. Take the example of a condition that occurs in infants called a haemangioma, which, like portwine stains, is also due to malformation of immature blood vessels.

In haemangiomas, small blood vessels come together to form a lump. Haemangiomas mostly affect the skin, usually on the head and neck, but they can occur in organs inside the body such as the liver. The skin lesions, which are often called strawberry marks because of their bright red, raised appearance, are not usually visible at birth but generally appear in the first week or so of life. They tend to grow rapidly in the first three months and then the growth rate slows. In most cases they disappear of their own accord by the time the child is five years old, leaving behind a faint pink mark or some loose skin.

However, some haemangiomas need treatment because of their position – for example, they may cover an eye or block the nose. Or treatment may be necessary because of other complications. Ulcerated haemangiomas may become infected, or heart failure may develop in patients with very large lesions because the heart has to pump so much blood through blood vessels in the lump. Until recently, steroids were the first-choice medical treatment for problematic haemangiomas.

Then in 2008, some doctors had dramatic results with another treatment, which they came across quite by chance. They were using steroids to treat a baby with a huge haemangioma that almost swallowed up the face and right eye. Despite this treatment, however, the baby developed heart failure. So, to treat the heart failure they started the baby on a standard drug for this condition called propranolol. To their astonishment, the appearance of the haemangioma started to improve within 24 hours, and within a week the tumour had shrunk sufficiently for the baby to open an eyelid. After six months of treatment the haemangioma had melted away.

Over the following year the doctors went on to use propranolol in a dozen children with similar success. These impressive results have been replicated by other doctors in small numbers of children and propranolol is now being studied further in larger numbers of infants. [7], [8]