Overview

 

Newborns often have temporary pimples or blotches that soon disappear as they adapt to life outside the womb. It's also quite common to see birthmarks on their skin at birth or shortly after. Birthmarks range from hardly noticeable to disfiguring, but no matter how large or small they are, they can be upsetting.

Birthmarks can be flat or raised, have regular or irregular borders, and have different shades of coloring from brown, tan, black, or pale blue to pink, red, or purple. The two main types of birthmarks are red, vascular birthmarks (for example, "strawberry" hemangiomas, port-wine stains, and "stork bites") and pigmented birthmarks (such as moles, café-au-lait spots, and Mongolian spots).

They're mostly harmless and many even go away on their own or shrink over time. Sometimes birthmarks are associated with other health problems, though, so talk to your doctor about whether this might be the case for your child.


What causes birthmarks?

Even though the cause of most birthmarks are unknown, there are many myths and popular beliefs surrounding them. One such popular belief is that if a pregnant woman touches her belly during an eclipse, her baby will have a birthmark. Another belief is that if a pregnant woman craves for a particular food and touches her womb, her baby will have a birthmark. However, these are just myths with no scientific explanation.


Are they ever serious?

Most birthmarks are harmless. However, it's wise to have your doctor check moles, especially large ones known as giant pigmented naevi, which are more likely than small moles to become cancerous over time. Your doctor will also want to keep a check on potentially problematic marks, such as port-wine stains which are near the eye, large haemangiomas on an arm, leg or near the eye, or large groups of brown marks. Any birthmarks (other than Mongolian spots) which are located on the lower spine may also need special attention.

Port-wine stains on the face or neck, even small ones, may bother a child tremendously and may even be psychologically damaging. In that case, specialised make-up can be used to disguise the area.

Types of Birthmarks

The two main types of birthmarks are differentiated by their causes. Vascular (blood vessel) birthmarks happen when blood vessels don't form correctly — either there are too many of them or they're wider than usual. Pigmented birthmarks are caused by an overgrowth of the cells that create pigment in skin.

Vascular Birthmarks

The most common vascular birthmarks are macular stains, hemangiomas, and port-wine stains : -

Macular stains. Also called salmon patches, angel kisses, or stork bites, these faint red marks are the most common type of vascular birthmark. They're often on the forehead or eyelids, the back of the neck, or on the nose, upper lip, or on the back of the head. They may be more noticeable when the baby cries. Most often they fade on their own by the time a child is 1 to 2 years old, although some last into adulthood.

Hemangiomas. Hemangiomas are classified as superficial when they appear on the surface of the skin ("strawberry marks") and deep when found deeper below the skin's surface. They can be slightly raised and bright red and sometimes aren't visible until a few days or weeks after a baby is born. Deep hemangiomas may be bluish because they involve blood vessels in deeper layers of the skin. Hemangiomas grow rapidly during the first 6 months or so of life, but usually shrink back and disappear by the time a child is 5 to 9 years old. Some, particularly larger ones, may leave a scar as they regress that can be corrected by minor plastic surgery. Most are on the head or neck, although they can be anywhere on the body, and can cause complications if their location interferes with sight, feeding, breathing, or other body functions.

Port-wine stains. These are discolorations that look like wine was spilled on an area of the body, most often on the face, neck, arms, or legs. Port-wine stains can be any size, but grow only as the child grows. They tend to darken over time and can thicken and feel like pebbles in midlife adulthood unless treated. They never go away on their own. Ones near the eye must be assessed for possible complications involving the eye.

Treating Birthmarks

Pigmented birthmarks are usually left alone, with the exception of moles and, occasionally, café-au-lait spots. Moles — particularly large or giant congenital nevi — sometimes are surgically removed, though larger ones may be more difficult to remove. Café-au-lait spots can be removed with lasers (highly concentrated light energy) but often return.

Vascular birthmarks, on the other hand, can be treated. The exception is macular stains, which usually fade away on their own; ones at the back of the neck may be more persistent but are not very noticeable.

Port-wine stains and certain hemangiomas can be disfiguring and embarrassing for children. Hemangiomas are usually left alone, as they typically shrink back into themselves by age 9. Larger or more serious hemangiomas often are treated with steroids.

Lasers are the treatment of choice for port-wine stains. Most lighten significantly after several treatments with a "pulsed-dye" laser, although some return and need re-treatment. Laser treatment is often started in infancy when the stain and the blood vessels are smaller. Marks on the head and neck are the most responsive to laser treatment. Special opaque makeup also can camouflage a port-wine stain.

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