#167: Vascular Anomalies: Hemangiomas, Malformations, and More

February 11, 2026 | By Sam Masur

Audio

In this episode, we are joined by pediatric dermatologist Dr. Sonal Shah to review vascular anomalies. Learn how to diagnose, evaluate, and treat lesions including infantile hemangiomas and capillary malformations.

Vascular Anomalies Pearls

1. Infantile hemangiomas undergo a period of rapid growth over the first few months of life and then gradually involute over a several year period.
2. Red flags for infantile hemangiomas include multiple (>5) cutaneous lesions, “beard” distribution, large segmental hemangiomas on the head and upper body, and large segmental hemangiomas in the lumbosacral region.
3. Infantile hemangiomas can be treated with topical or systemic beta-blocker therapy.
4. Capillary malformations located along the ophthalmic and maxillary distribution of the trigeminal nerve can be associated with Sturge-Weber syndrome, which can cause seizures and glaucoma.

Vascular Anomalies Notes 

Vascular Anomalies

Vascular anomalies are divided into two broad categories, vascular malformations and vascular tumors.

• Vascular malformations: non-neoplastic and congenital, related to error in development of vascular endothelial cells
• Vascular tumors: neoplastic with increased rate of proliferation of vascular endothelial cells, can be benign or malignant

Infantile Hemangiomas

Infantile hemangiomas are a type of benign vascular tumor with characteristic bright red color.  They generally are NOT present at birth and develop in the first few months of life. These are different from congenital hemangiomas which develop in utero and are fully-formed at birth.

Natural Course

Most will have a rapid period of growth between 1-3 months and then reach a late proliferation phase before plateauing and spontaneously involuting over the course of several years (although may not fully resolve). 

Complications

Complications include ulceration and destruction of cartilage.

Red Flags

The Infantile Hemangioma Referral Score can help pediatricians decide when to refer to a pediatric dermatologist. Characteristics of infantile hemangiomas that should raise red flags for other issues include:

• Multiple (>5) cutaneous hemangiomas – obtain abdominal ultrasound to rule out liver involvement 
• “Beard” distribution along jaw, lower neck, and lip – associated airway hemangiomas can cause obstruction and stridor, perform airway evaluation
• Large (>5 cm) segmental hemangiomas involving the face, neck, upper trunk or extremities – concern for PHACE syndrome which can cause cerebrovascular and cardiac anomalies including stroke and coarctation of the aorta, perform echocardiogram and MRI/MRA brain, neck, chest
• Large (>2.5 cm) segmental hemangiomas of the lumbosacral area –concern for LUMBAR syndrome which can cause urogenital and spinal anomalies, obtain ultrasound or MRI of spine

Treatment

Consider treatment for lesions that are at risk of causing disfigurement and functional impairment. Should be a shared-decision with families. Initiating treatment early during the first 1-3 months is important as it targets the most rapid period of growth and can lead to better outcomes. Treatment can include medications, laser therapy, and surgical excision.

• Timolol: Local therapy good for small, superficial, flat infantile hemangiomas. Comes in a gel-forming solution. Dosage is typically 1 drop twice daily.
• Propranolol: Systemic therapy. Avoid in patients with cardiac or respiratory issues. Dosing starts at 0.5 mg/kg/day divided into two doses and gradually uptitrated to a goal of 2 to 3 mg/kg/day. Common side effects include diarrhea, sleep disruption, fussiness, bradycardia, hypotension, bronchospasm, and hypoglycemia. To avoid hypoglycemia, medication should be given with or following feeds.

Capillary Malformations

Capillary malformations (often called port-wine stains or nevus flammeus) are flat pink or red patches due to extra capillaries near the surface of the skin. Many infants have birthmarks called “stork bites” (forehead) or “angel kisses” (back of neck) that are a type of capillary malformation also known as nevus simplex. These birthmarks tend to fade over time and are not associated with underlying conditions. In contrast, other types of capillary malformations tend to progressively darken and hypertrophy with time. Treatment can include laser therapy

Sturge-Weber Syndrome

Associated with capillary malformations in the ophthalmic and maxillary distribution of the trigeminal nerve. Clinical manifestations include ocular, leptomeningeal, and brain abnormalities such as seizures, glaucoma, and developmental delay.

Links

1. VisualDx
2. Hurwitz Clinical Pediatric Dermatology
3. AAP Chapter on Vascular Anomalies

Goal

Listeners will explain the diagnosis, evaluation, and treatment of vascular anomalies including infantile hemangiomas and capillary malformations. 

Learning Objectives

After listening to this episode listeners will…  

1. Explain the difference between vascular tumors and vascular malformations.
2. Describe the natural course of infantile hemangiomas.
3. Identify risk factors of infantile hemangiomas that require further evaluation.
4. Recognize syndromes that can be associated with extensive capillary malformations.

Disclosures

Dr. Shah reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Mao C, Shah S, Berk J, Chiu C, Masur S. “#167: Vascular Anomalies: Hemangiomas, Malformations, and More”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ February 11, 2026.