Audio podcast - Ulcerated Haemangioma

A haemangioma is the most common type of birthmark, listen to the podcast on this page to find out more about how to clean and dress an ulcerated haemangioma.

Ulcerated haemangiomas and why they might need special care:

A haemangioma is a collection of small blood vessels that form a lump under the skin. They are sometimes called ‘strawberry marks’ because the surface of a haemangioma looks a bit like the surface of a strawberry.

It is a benign (non-cancerous) tumour of the cells, called endothelial cells, which normally line the blood vessels. In haemangiomas, the endothelial cells multiply at an abnormally rapid rate. This collection of small blood vessels forms a lump in or under the skin.

In most cases haemangiomas just need looking after carefully. The blood vessels are near the surface of the skin, so they can bleed if knocked or scratched. If a haemangioma starts to bleed – apply pressure using gauze for five minutes, securing the pad in place.

Do not look under the gauze to see if the bleeding has stopped, if blood soaks through the gauze, do not remove it but add another pad on top. If you are at all concerned, take your child to the nearest accident and emergency department.

Occasionally haemangiomas can cause an open sore or ulcer which is painful. Ulcers can become infected, so a visit to your doctors is important, as your child may need antibiotics.

Haemangiomas that are near the mouth, in the nappy area, or in natural folds of skin like the armpit, ear, or neck are most likely to become ulcerated. This is often due to the friction of the two skin surfaces rubbing together.

If your child’s haemangioma develops an ulcer it will need special attention until it heals.

Cleaning and dressing an ulcerated haemangioma.

Always have the dressing materials and cleaning solution prepared before you remove the old dressing.

You will need:

• Two pieces of gel based dressing large enough to cover the haemangioma and two pieces of alginate dressing of the same size.

• Gauze squares – enough to cover an area twice the size of the haemangioma, and two/three gauzes deep. If your babies’ haemangioma is on the head or face, you will need extra gauze to clean it.

To hold the dressing in place you will need:

• A bandage

• A length of stretchy tubular bandage

• Easy to remove surgical tape

For the cleaning solution you will need:

• Potassium manganite crystals (sometimes you will be given tables instead – crush one tablet in a tablet crusher to make a fine powder)

• Large bottle or jug of cooled, boiled water

• Antibiotic ointment (if prescribed)

How to prepare the dressing:

1. Wash your hands thoroughly with soap and water.

2. Get a clean surface ready – a tray or container that you only use for preparing dressings.

3. Open the packets of gauze squares.

4. Open the other packets of the gel based and alginate dressing but don’t remove the inner packaging for the moment.

5. Remove the cardboard from the alginate dressing and put one piece on top of the gauze.

6. Moisten the remaining piece of alginate dressing with a little of the cooled, boiled water and put it on top of the dry dressing and gauze.

7. Remove one side of the gel based dressing inner packaging, and put antibiotic ointment on the surface.

8. Remove the other side of the gel based dressing and put it on top of the alginate dressing and gauze with the antibiotic ointment upwards. This sandwich of dressings is now ready to apply once you have removed the old dressing and cleaned the haemangioma.

How to prepare the cleaning solution:

• Put a very small amount of potassium crystals into a small bowl and add a little of the cooled, boiled water. When you’ve mixed the crystals and water together, the solution should be a purple colour. This is the solution you need if your babies’ haemangioma is in the nappy area.

• If your babies’ haemangioma is on the arm, leg, body, or head, add enough of this solution to the bottle or jug of cooled, boiled water to turn to a pale pink colour.

How to clean and dress an ulcerated haemangioma in the nappy area:

1. Fill a baby bath with warm water, so that it’s deep enough for the ulcerated area to be covered without your baby sitting on the bottom of the bath.

2. Using the purple solution saved from when you prepared the cleaning solution, add enough to turn the bath water pale pink.

3. Put your baby in the bath for three minutes to soak.

4. If the dressing has soaked through enough, remove it gently. If it is still in place, leave it to soak for a few minutes more.

5. Lift your baby out of the bath and dry the rest of the body as usual. Do not wipe or rub the haemangioma.

6. Dry the haemangioma with a hairdryer on the cool setting.

7. Apply the dressing sandwich that you prepared earlier with the antibiotic ointment next to the skin. You do not need to secure the dressing with tape as your babies’ nappy will hold it in place.
   

You should repeat these steps twice a day, but you might need to change the dressings at nappy changes, if it’s wet or soiled. If you do need to change it then, poor cooled, boiled water over the area, and replace the antibiotic ointment in the dressing sandwich with petroleum jelly.

How to dress an ulcerated haemangioma on the arm, leg or body:

1. Fill a baby bath with warm water, and put your baby in it as usual.

2. Pour the bottle or jug of pale pink solution gently over the haemangioma - soak the dressing well so that it’s easier to remove.

3. Lift your baby out of the bath and dry the rest of the body as usual. Do not wipe or rub the haemangioma.

4. Dry the haemangioma with a hairdryer on the cool setting.

5. Apply the dressing sandwich that you prepared earlier with the antibiotic ointment next to the skin.

6. Secure the dressing using a bandage if the haemangioma is on your baby’s arm or leg. Use a stretchy tubular bandage vest if it’s on the body.

How to clean and dress an ulcerated haemangioma on the head or face:

1. Soak a piece of gauze in the pale pink solution.

2. Put it directly onto the haemangioma but don’t wipe or rub it.

3. Leave it in place for 30 seconds and then gently remove it.

4. Repeat these first three steps six times.

5. If possible, dry the area with a hairdryer on a cool setting. Otherwise leave it to dry naturally for four-five minutes.

6. Apply the dressing sandwich that you prepared earlier with the antibiotic ointment next to the skin.

7. Secure the dressing with a stretchy tubular bandage balaclava if possible, or use a small amount of easily removable surgical tape.