Discovering a rapidly growing red mark on a young baby can be alarming, particularly when it was not present or was barely noticeable at birth. Infantile haemangiomas — often referred to as strawberry marks or strawberry naevi — are the most common vascular tumours of infancy, and for most families the key information they need is that these are benign, follow a predictable natural history, and the vast majority will resolve without any treatment.
Understanding what haemangiomas are, what to expect as they evolve, and which features are worth discussing with a GP or paediatric dermatologist helps parents distinguish the reassuring from the genuinely concerning.
Healthbooq supports parents with evidence-based guidance on common infant skin conditions, including vascular birthmarks and when specialist referral is appropriate.
What Infantile Haemangiomas Are
An infantile haemangioma is a benign overgrowth of blood vessels in the skin, arising from rapid proliferation of vascular endothelial cells. Unlike port-wine stains (which are flat, present at birth, and do not change significantly) and salmon patches (stork marks, which are very common, faint pink, and typically fade), infantile haemangiomas are characterised by their growth in infancy followed by spontaneous involution.
They affect around four to five per cent of all infants, are more common in premature babies, girls, and multiple births, and are more common in white-skinned infants. They may be superficial (raised, bright red, with a "strawberry" surface), deep (subcutaneous, with normal-appearing or faintly discoloured overlying skin), or mixed.
Natural History: Growth, Plateau, and Involution
Infantile haemangiomas typically follow a characteristic course. Most are not visible at birth, or present as a faint precursor mark (a small pale area, telangiectatic patch, or bruise-like area). Within the first one to four weeks of life, rapid growth begins. Growth is most rapid between one and three months and typically reaches a plateau by three to five months. In a minority of haemangiomas, growth continues to nine to twelve months.
After the growth phase, gradual involution begins. Involution progresses slowly: by three years, approximately half of haemangiomas have significantly involuted; by five years, approximately fifty to sixty per cent have largely resolved; by ten years, seventy to ninety per cent have involuted. Involution is characterised by the colour changing from bright red to greyish-red, the surface becoming less raised, and the centre beginning to flatten and fade.
Around half of resolved haemangiomas leave no residual mark. The other half leave some residual change — typically a pale, slightly fibrofatty area, or telangiectatic vessels — the significance of which depends on location (facial haemangiomas are more likely to be cosmetically significant).
When Intervention Is Needed
The majority of infantile haemangiomas are small, uncomplicated, and managed expectantly (monitored without treatment). However, a minority require treatment, either because of functional risk or complication.
Periocular haemangiomas (near or on the eyelid) may obstruct the visual axis and cause amblyopia (lazy eye) — one of the most urgent indications for treatment. Haemangiomas of the lip, nasal tip, and ear require specialist assessment because of the cosmetic and functional complications of involution in these areas. Large or segmental facial haemangiomas may be associated with internal haemangiomas (particularly on the airway or liver) and require investigation. Large haemangiomas of the nappy area or skin folds are prone to ulceration — a painful complication that is the most common reason for intervention in haemangiomas that would otherwise be watched.
Ulceration presents as a painful, open area within the haemangioma, often with surrounding white tissue; it requires wound care and may require medical treatment to accelerate resolution.
Treatment
The first-line treatment for infantile haemangiomas requiring intervention is oral propranolol (a beta-blocker), which has been shown to be highly effective at halting growth and accelerating involution. It is given under specialist supervision because of potential side effects (hypoglycaemia, bradycardia) and requires an initial monitored dose in a clinical setting. Propranolol has transformed the management of complicated infantile haemangiomas — children who previously would have needed surgery or laser treatment frequently achieve excellent outcomes with propranolol alone.
When to Seek Advice
Any haemangioma near the eye warrants early GP referral for specialist review. Large or rapidly growing haemangiomas, haemangiomas of the lip, nasal tip, or ear, and any haemangioma that ulcerates should be discussed with a GP, who can refer to paediatric dermatology or plastic surgery. For uncomplicated, small, superficial haemangiomas away from the face, the main role of the GP visit is confirmation of the diagnosis and reassurance about natural history.
Key Takeaways
Infantile haemangiomas — commonly called strawberry marks — are the most common vascular tumours of infancy, affecting approximately four to five per cent of infants. They are not present at birth or are barely visible as a faint mark, grow rapidly in the first weeks to months of life, reach maximum size between three and five months, then gradually involute (shrink) over the following years. The majority are small, uncomplicated, and require no treatment. A minority require intervention because of location (near the eye, airway, or lip), size, or complications such as ulceration. Treatment, when indicated, is with oral propranolol.
