# Infantile Haemangioma > Infantile haemangioma for NEET-PG Dermatology covering natural history, GLUT-1 staining, propranolol therapy, PHACE screening and complicated sites. - Canonical URL: https://prepelephant.com/topics/neet-pg/dermatology/infantile-haemangioma - Exam / course: NEET-PG · Subject: Dermatology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-14 - Last updated: 2026-10-14 - Reference basis: Fitzpatrick's Dermatology; Rook's Textbook of Dermatology; Nelson Textbook of Pediatrics - How to cite: "Infantile Haemangioma", PrepElephant, https://prepelephant.com/topics/neet-pg/dermatology/infantile-haemangioma ## Direct answer Infantile haemangioma is the commonest benign vascular tumour of infancy, a GLUT-1 positive endothelial proliferation that appears in the first weeks of life, grows during a proliferative phase and then involutes over years. Most lesions need only observation, but those in critical sites such as the airway, eyelid, lip or perineum, or those that ulcerate, need treatment. Oral propranolol is the first-line systemic therapy for these complicated lesions. ## What you must remember - **Phases:** a proliferative phase in the first year, a plateau, then involution over several years, with residual skin laxity or telangiectasia often remaining. - **Risk factors:** female sex, prematurity, low birth weight, white ethnicity and placental anomalies such as placenta previa. - **Marker:** GLUT-1 is expressed by the endothelial cells of infantile haemangioma but not by vascular malformations. - **Types:** superficial lesions are bright red and raised, deep lesions are bluish and subcutaneous, and mixed lesions have both components. - **Complications:** ulceration, bleeding, infection, airway obstruction, amblyopia from periocular lesions, and permanent scarring. - **PHACE association:** posterior fossa malformations, haemangioma, arterial anomalies, cardiac defects and eye abnormalities, typically with large segmental facial lesions. - **Treatment:** oral propranolol for complicated lesions, topical timolol for small superficial lesions, and systemic corticosteroids as a second-line option. ## From a red lesion to the decision to treat Almost all infantile haemangiomas can be managed by watchful waiting, so the task is to recognise the few that threaten function. The steps below follow a logical bedside approach. 1. **Note the phase:** a lesion still growing in the first year is proliferative, whereas one that has stopped growing is in the plateau phase. 2. **Map the site:** lesions on the eyelid, nose, lips, ear, perineum or airway region are high-risk for complications. 3. **Look for ulceration:** an ulcerated lesion is painful and prone to infection and scarring, and needs wound care and early treatment. 4. **Screen for PHACE:** a large segmental facial haemangioma prompts cardiac, neurological and eye assessment, with brain imaging when indicated. 5. **Check the airway:** stridor, or a segmental lesion in the beard distribution, calls for urgent ENT or airway review. 6. **Start propranolol:** oral propranolol is started under paediatric supervision for lesions that threaten function, with monitoring for bradycardia and hypoglycaemia. 7. **Observe the rest:** most lesions are followed with serial photographs to track involution and to warn parents about residual skin change. ## Where the exam tries to catch you Infantile haemangioma is often confused with vascular malformations and is sometimes treated too aggressively. - **Trap:** treating every haemangioma aggressively. **Correct:** most lesions involute spontaneously, so treatment is reserved for complicated or high-risk sites. - **Trap:** calling a lesion present from birth a haemangioma. **Correct:** haemangiomas usually appear in the first weeks of life and grow, whereas malformations are present from birth, grow proportionately and do not involute. - **Trap:** assuming a large facial haemangioma is harmless. **Correct:** segmental facial lesions can signal PHACE association, so brain, cardiac and eye screening is needed. - **Trap:** starting propranolol without checking heart rate and glucose. **Correct:** propranolol can cause bradycardia and hypoglycaemia, so baseline assessment and monitoring are essential. ## Frequently asked questions ### What is the natural history of infantile haemangioma? Infantile haemangioma passes through a proliferative phase in the first year, plateaus, and then involutes over several years. Most lesions regress substantially, although residual skin laxity, telangiectasia or scarring may remain. ### Which drug is first-line for complicated infantile haemangioma? Oral propranolol is the first-line systemic treatment for complicated infantile haemangioma, such as lesions threatening the airway or vision, or those causing ulceration. It is started under paediatric supervision, with monitoring for bradycardia and hypoglycaemia. ### Which marker differentiates infantile haemangioma from vascular malformation? GLUT-1 positivity of endothelial cells distinguishes infantile haemangioma from vascular malformation, which is GLUT-1 negative. Clinically, malformations are present from birth and grow with the child rather than involuting. ### Why is a segmental facial haemangioma evaluated for PHACE? Large segmental facial haemangiomas can be associated with PHACE syndrome, which includes posterior fossa malformations, arterial anomalies, cardiac defects and eye abnormalities. Brain and cardiac imaging looks for these associated features when indicated. ### Which sites of infantile haemangioma need urgent review? Lesions on the airway region, eyelid, nose, lips, ear and perineum need urgent review, because they risk obstruction, amblyopia, ulceration or functional damage. Segmental lesions in the beard distribution can also be associated with airway involvement.