Haemangioma (strawberry nevus)

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 may look a bit like the surface of a strawberry.

Superficial haemangiomas are usually a raised, bright red area of skin, which feels quite warm because the abnormal blood vessels are close to the surface. A superficial haemangioma may appear initially as a small area of pale skin on which a red spot develops.

Deep haemangiomas may appear bluish in colour because the abnormal blood vessels are deeper in the skin. Sometimes they are not noticeable for the first few weeks, only appearing as a lump as the haemangioma grows. This is particularly true if the surface of the skin is not affected.

Haemangiomas are not usually present at birth but develop a few days or weeks later. They often grow rapidly in the first three months. It is unusual for haemangiomas to grow after six to 10 months of age, when most haemangiomas tend to have a ‘rest period’ and then begin to shrink.

As the blood vessels in a haemangioma are so near the surface of the skin, they can bleed if they are scratched. It is important to keep nails cut short and buffed smooth, so that they don’t catch the surface of the haemangioma.

If the haemangioma starts to bleed, apply pressure over it with a clean handkerchief, cloth or tissue for at least five minutes. If blood soaks through the handkerchief, cloth or tissue, put another one on top and keep up the pressure. Do not take it off to have a look as this could start the bleeding again.

If the bleeding continues, even after pressing down on the haemangioma for five minutes, we recommend people go to their nearest NHS Walk-In Centre or Accident and Emergency department

A beta blocker called Propranolol may be needed when the haemangioma is near the eye, lips, or nappy area. Treatment may need to continue for 18 months or longer but results are promising.

Tests for Cow’s milk (protein) allergy

I get asked this very often when I diagnose CMPA in a baby. The most common type of CMPA is Non IgE mediated. It presents at the age of 4-6 weeks onwards. The symptoms are dry skin, reflux (unsettled, vomity baby), runny stools or worsening constipation. Some babies are also snuffly and have blocked nose, all the time.

The severe form, which is IgE mediated CMPA, presents earlier, within days as vomit as soon as milk is given (usually formula), sneezes, rash over face and sometimes breathing difficulty. This can be diagnosed with a blood test (specific IgE for milk) or a skin prick test to milk. Fortunately, this is much less common than Non IgE mediated cases.

There is no test for the Non IgE mediated CMPA as IgE (Immunoglobulin E) is not involved in the allergy. It is still a true allergy. The good thing is that children with this condition grow out of it between the age of 1 to 2 years. (IgE mediated CMPA may persist for 7-8 years or even longer).

The best test is going dairy free (if you are breast feeding) or giving a special (Extensively Hydrolysed) formula, which is on prescription (Aptamil Pepti, Nutramigen or Similac Alimentum). They all taste bad but the babies get used to it pretty quickly as their taste buds are not very well developed. It may take 2-4 weeks before you see marked improvement in symptoms.

Then at 4 weeks, you reintroduce the dairy in babies or mother’s diet.

If symptoms return – It confirms CMPA and you should go back to ‘dairy free diet’

If they don’t – It possibly was not CMPA and you can relax !

https://www.allergyuk.org/assets/000/002/176/iMAP_2_Management_of_Mild_to_Moderate_Non-IgE_Cow’s_Milk_Allergy_original.pdf?1539852537

 

Peanut Immunotherapy (desensitisation)

There have been recent trials for Peanut Immunothearpy, which have been quite successful. Sublingual Immunotherapy for Peanuts is also being trailled and if successful, will be veru useful, as many children who are allergic to Peanuts, do not want to eat Peanut for the desensitisation.

https://www.evelinalondon.nhs.uk/about-us/news-events/2018-news/20181119-landmark-study-peanut-allergy.aspx

Currently, the only clinic that I can find offering Immunotherapy for Peanut is at Addenbrooks Hospital, Cambrodge.

http://www.peanut.cuh.org.uk/

EEG (Electroencephalogram)

EEG or trace of the brain is used to pick up electrical brain activity in the brain by placing leads on the head. It is very similar principal to ECG (Electrocardiogram), which picks up electrical activity of the heart.

Epilepsy, though is primarily a clinical diagnosis as EEG can be normal in children with Epilpepsy and many normal people (upto 5%) can have abnormal EEG. It is helpful though to know the type of seizures, their origin etc.

Various types of EEG are described in this section in the excellent Epilepsy Society website https://www.epilepsysociety.org.uk/eeg-electroencephalogram#.XD-4qc_7St8

Persistent swollen glands (Lymphadenopathy)

Persistently enlarged lymph nodes (glands) cause terrible anxiety in parents. They are most commonly caused by infections. They are usually limited to the area they drain, for example in the neck after infections of throat/ear/scalp etc. Sometimes it can take weeks or months for them to shrink in size and that can be worrying for parents and carers.
Most often, parents only need reassurance but if there are features like fever, night sweats, weight loss etc. or if there is generalised enlargement in multiple places, then, blood tests can be done to rule out rare but serious conditions like Leukaemia and Lymphoma etc.

https://www.nhs.uk/conditions/swollen-glands/