Vascular lesions near eye may require medical intervention

As partners in a group practice, my five fellow pediatricians and I share in the care of a number of patients ranging from infancy through college age. For this reason, I found myself walking into an exam room to check out a 1-year-old who I hadn't seen since his two-week well-baby exam.

I was happy to see that my patient was growing well and looking healthy. Mom and dad quickly brought me up to speed on the little guy's health history, which thankfully was medically unremarkable.

Except, that is, for the red lesion visible on the child's upper eyelid.

The parents and I discussed this skin condition, known as a hemangioma or "strawberry mark" - a vascular lesion made up of the endothelial cells that normally line blood vessels. The hemangioma had not been present at our two-week visit, instead making its debut a few weeks later.

As was typical for such lesions, the hemangioma had grown with the boy during his first year of life. What was not typical was that the area required medical intervention.

While most vascular lesions grow and then gradually shrink and fade away on their own, some do need to be addressed due to location. Because of the birthmark's proximity to the eye, the child was under the care of an ophthalmologist and a pediatric dermatologist.

Since some eyelid hemangiomas can grow large enough to obstruct vision, the pediatric dermatologist was attempting to shrink the mass with steroid injections. The child's parents and specialists were all pleased with the results, and at 1 year old, the little boy was left with a small, flat residual red spot over a portion of his upper eyelid.

According to the Vascular Birthmarks Foundation, only 30 percent of these "birthmarks" are actually seen in the delivery room, with the remainder becoming visible sometime within the first month of life. More than 80 percent of these birthmarks develop on the head and neck. Hemangiomas are known to have a much higher incidence in female and Caucasian patients.

The foundation notes most hemangiomas steadily increase in size until toddlerhood. The majority will then slowly involute, or fade away, during the next three to 10 years of life, eventually changing from raised red to flat gray skin marks.

Researchers at the Children's Hospital of Wisconsin find most kids experience no complications from hemangiomas. However, approximately 25 percent of these children will run into problems due to visual impairment when lesions are near the eye; ulceration or skin breakdown, seen particularly with lesions located around the mouth, nose, ear or diaper area, and bleeding, usually controlled with the application of 15 minutes of steady pressure.

When hemangiomas affect health, such as in children with lesions located near the eye or airway, or in cases where hemangiomas create a major cosmetic impact, Children's Hospital of Wisconsin specialists advise parents to discuss available treatment options with their child's doctor.

Current therapies for these vascular tumors include topical, injectable or oral steroids; laser treatment; surgical removal; interferon injections; embolization and the use of newer topical gels. Therapy should be directed and performed by physicians specializing in the care of pediatric vascular lesions.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.