Infantile haemangioma: topical timolol

What are strawberry marks (infantile haemangiomas)?

Strawberry marks (infantile haemangiomas) are the most common type of birthmark, and usually appear during the first 4–6 weeks of life. They are caused by abnormal blood vessels growing in the skin or deep under the skin, or a combination of both. Haemangiomas near the surface of the skin are usually raised, bright red areas. Deep haemangiomas may appear blue in colour. Mixed haemangiomas grow near the surface and deeper under the skin. Haemangiomas are sometimes not noticed for the first few weeks after birth, and only appear as a swelling as they grow. Haemangiomas often grow quickly in the first 3 months of life and sometimes become redder. It is unusual for them to grow after 6–10 months; at this age most haemangiomas tend to stay the same size for a while and then begin to shrink. See Great Ormond Street Hospital's information on treating small infantile haemangiomas with topical timolol for more details.

Most infantile haemangiomas do not need treatment. But they need to be looked after carefully because they can bleed if they are scratched. If treatment is needed, this may include 'off‑label' steroids taken by mouth, injected or applied as a cream; 'off‑label' beta‑blockers taken by mouth (such as propranolol) or applied as a solution or gel directly to the surface of the haemangioma (such as timolol); laser treatment or surgery. Emollient creams (moisturisers), dressings, pain relief and antibiotics may also be needed.