Infantile haemangiomas are soft, raised swellings on the skin, often with a bright, red surface. They are a non-cancerous overgrowth of blood vessels in the skin. They are commonly known as 'strawberry birthmarks', 'strawberry naevi', or 'capillary haemangiomas'. They occur in five per cent of babies, with the majority appearing within the first few weeks of life, and reach their full size at about three to six months of age. The vast majority are uncomplicated and will shrink on their own by five to seven years of age and require no further treatment. However, some infantile haemangiomas may occur in high-risk areas (such as near the eyes and nose which can result in impairment to vision and airway obstruction, respectively) and some of them are disfiguring and psychologically distressing to the children and their parents. Some may also develop complications so early medical treatment may be necessary. Corticosteroids are currently the standard treatment; however, it is not known which of a variety of treatments is best.
Four trials (ranging from 20 to 121 participants) were included in this review. Two assessed treatments which are no longer used (bleomycin and radiation), with neither trial finding clinically important improvements. From the other two trials limited evidence in relation to clinically important improvements were seen.
One trial assessed the use of photodynamic laser (PDL) therapy. Haemangiomas were more likely to completely clear with PDL when compared to a 'wait and see' approach at one year. However, there were significant side-effects, and it was noted that most of the birthmarks treated with PDL would have resolved naturally over time.
One trial compared an oral corticosteroid (prednisolone) with an intravenous corticosteroid. Haemangiomas were more likely to reduce in size using the oral corticosteroid as compared to the intravenous corticosteroid at three months and one year. Similar numbers of side-effects were being seen in both groups.
We found eight ongoing trials, four of which were designed to assess the effectiveness of oral propranolol either against placebo or an oral corticosteroid. Propranolol has become the second-line treatment since the publication of the protocol of this review in 2007; therefore, it is important that this review is updated within the next three years so these studies can be assessed and added to the evidence base to inform clinical practice.
There is limited evidence of the effectiveness of treatments for those birthmarks that require treatment because the data has come from small trials. The treatments used for haemangiomas need to be tested in large, well-designed trials.