NEW YORK (Reuters Health) - Many children with so-called "strawberry birthmarks" on their faces and other body regions appear to do just as well when doctors let the mark disappear naturally as when it is treated using laser therapy, new study findings suggest.

Dr. Kapila Batta of the Birmingham Children's Hospital NHS Trust in Birmingham, UK, and colleagues found that children were just as likely to see their birthmarks disappear by one year of age whether they were given the laser therapy or not. Furthermore, parents of treated children were just as likely as other parents to claim the birthmarks were a problem by the time the infants turned one.

"Most (of these birthmarks) will resolve completely and require no treatment and can be simply observed," Batta told Reuters Health.

During the study, the investigators compared treatment with lasers to no treatment in infants between 1 and 14 weeks old who had early, uncomplicated strawberry birthmarks, also known as hemangiomas. The researchers excluded children with large facial lesions, those with mixed and deep types of hemangiomas and children with lesions involving the eyelid.

Hemangiomas are the most common type of tumor involving soft tissues that occurs in children, occurring in between 10% and 12% of infants before they turn 1. Most develop after birth, with the vast majority appearing before the baby is 4 weeks old. The marks tend to reach full size by the time the infant reaches 8 months of age.

Most of these birthmarks are harmless, but some can cause potentially serious complications, such as painful ulceration, infection, bleeding and disfigurement. In general, hemangiomas do not last: previous studies have shown that many of these birthmarks disappear on their own by the time the child is 10.

Since so many of hemangiomas disappear on their own, most doctors have adopted a "wait-and-see" approach with the marks. However, recently some doctors have proposed treating the marks using pulses of lasers, which have been shown to help with less common birthmarks known as port-wine stains.

As part of the trial, Batta and colleagues administered laser treatment to 60 infants with hemangiomas, and simply observed another 61 over time.

In an interview with Reuters Health, Batta explained that lasers work by emitting light that becomes absorbed by the red pigment in blood vessels that occur in hemangiomas. "The energy of the laser is converted into heat which seals the blood vessels but does not damage the surrounding skin," Batta noted.

But comparing lasers to no treatment at all, the researchers found that around 40% of children who received the laser treatment saw their hemangiomas disappear by age 1, a rate similar to that experienced by their untreated peers.

Furthermore, the authors report in the August 17th issue of The Lancet, children who received laser therapy were more likely than others to experience certain complications at the treated site, such as a thinning or lightening of the skin.

Batta added that in some cases, parents might still want to consider treatment for their child's hemangioma. Laser treatment "can improve any residual redness after the hemangioma has naturally resolved. It can also reduce pain and speed healing in ulcerated lesions," Batta noted.

In an accompanying editorial, Ulrich Hohenleuter and Michael Landthaler of the Klinikum der Universitat in Regensburg, Germany, reinterpret previous findings from their own research as a result of the recent report.

"In our series of 617 hemangiomas, we were able to stop the growth of 97% with an (average) of 2.5 laser treatments. In view of Batta's results, however, we should concede that these results might have been the same if we had done no treatment at all, and that all or most lesions could have stopped growing spontaneously," they write.

Although most childhood hemangiomas can likely be left alone, the editorialists agree that in some cases, treatment may be warranted.

"If disfigurement or other complication can be avoided or amended in even a small number of children, we believe treatment is worth a try," Hohenleuter and Landthaler write.

SOURCE: The Lancet 2002;360:502-503, 521-527.

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