By Gary M. White, MD

Several types of congenital hemangiomas occur.


The RICH is a vascular papulonodule that is fully formed at birth. It may be a few to many centimeters in diameter. The head and neck are the most common sites. Ulceration may occur. Rarely, a RICH may be complicated by may present with transient thrombocytopenia and cardiac overload [Ped Derm 2014;31:402].

Lesions may rapidly involute within weeks or may do so over many months--up to 16 months. Rarely, lesions involute in utero. Some RICH only partially involute, leaving a PICH [JAAD 2014;70:899-903].

Ulceration, complicated by life-threatening hemorrhage may rarely occur [JAMA Derm 2015;151;422].


No treatment is needed, but surgery may be done for persistent, redundant skin.


Excellent response to prednisone. Dermatology Journal Online 14(4).


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