Birthmarks

Definition

Birthmarks are colored spots on the skin that babies are born with or develop shortly after birth. More than 10 in 100 babies have birthmarks.

These marks vary in color from bright red, pink, brown, tan, and bluish. Birthmarks can be flat on the surface of the skin or raised. Birthmarks are labeled by their colors and consistencies.

The most common type of birthmarks include:

Café-au-lait spots—These are light tan colored spots. Having up to three such spots on your body is usually fine. Having more than three café-au-lait spots can possibly indicate a condition called neurofibromatosis , a genetic disorder that causes skin tumors.

Hemangiomas—These are usually flat or slightly raised and bright red or bluish in color. They may appear anywhere on the body, but are often found on the face, head, and neck. Hemangiomas are usually present at birth or develop during the first few weeks of life. These birthmarks tend to grow quickly during the first 12 months of your child’s life. But they tend to stop growing after the first year and then slowly disappear. They may also be found inside the body. Two types of hemangiomas include:

  • Strawberry hemangioma—This type of hemangioma is usually raised up a bit from the skin and bright red like a strawberry. This bright red coloring is due to numerous, dilated blood vessels found close to the surface of the skin. These hemangiomas usually go away on their own by age ten (age five in almost half of children). Most do not require any treatment, unless they ulcerate or are located in places where they could impair normal body functions, such as around the mouth, nose, eyes, anus, or throat.
  • Cavernous hemangioma—This type of hemangioma is beneath the skin. It is puffier than a strawberry hemangioma and also more bluish in color. These types of hemangiomas are less likely to resolve on their own. Facial hemangiomas are occasionally associated with similar vascular malformations of the brain, so your physician may recommend MRI imaging to determine whether this is present.

Macular stain—These are often called angel’s kisses or stork bites. These harmless birthmarks are pinkish or light red and can be found anywhere on your child's body, but most commonly on the back of the head and neck. Usually they are barely visible. No treatment is necessary for this type of birthmark.

Moles—Moles appear as dark brown or black spots. Nearly everyone has small moles. They usually begin to appear after birth and are actually small groupings of colored (pigmented) skin cells.

Mole

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© 2008 Nucleus Medical Art, Inc.

Mongolian spots—These flat birthmarks on the surface of the skin have a blue-gray color and are often located on the buttocks or base of the spine. These types of birthmarks are generally harmless, however, they are sometimes mistaken for bruises. They tend to disappear by puberty.

Port-wine stains—Pink, red, or purple colored blotches on the skin. Their size varies and can be found on the face, neck, arms, or legs. Although there are treatments to minimize the appearance of port-wine stains, they are permanent. Large port-wine stains on the face may be indicative of a condition called Sturge-Weber syndrome that can result in seizures and mental retardation.

Congenital hairy nevus (giant hairy nevus, bathing trunk nevus)—this is a dark, textured mole, present from birth. Many of these will also be covered at least in part with hair, but some are not. They may be very large, covering the abdomen and thighs in a “bathing trunk” distribution, or smaller. They may be multifocal. This particular birthmark can develop into melanoma at some point in life. It is generally removed as soon as feasible, depending on size, location, and need for reconstructive surgery to achieve a good cosmetic result.

Causes

The exact cause of birthmarks is unknown.

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. The following factors increase your chances of developing particular birthmarks:

  • Hemangiomas are more common in females and premature babies
  • Mongolian spots are more common among Asians, East Indians, Africans, Native Americans, and Hispanics
  • Café-au-lait spots are more common in African-Americans than other ethnic or racial groups

Symptoms

If you or your child experiences any of these symptoms do not assume it is due to birthmarks. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.

Symptoms include:

  • Changes in the color of the skin (lighter or darker than usual)
  • Lumps or swelling on the skin
  • Changes in texture of the skin
  • New lesions on the skin

Birthmarks:

  • May differ in size and appearance
  • Are most likely present at birth or appear in the first few weeks or months of life
  • Are commonly found on face and neck

Most of these birthmarks, though cosmetically undesirable, are generally harmless. However, hemangiomas and port-wine stains may produce some complications:

Hemangiomas

  • Open sore or ulcer
  • Interference with the appearance or function of nearby structures (eg, eye or mouth)
  • Excessive bleeding after an injury
  • Sudden and rapid growth

Port-wine Stains

  • Emotional and social complications
  • Interference with the function of nearby structures (eg, eye)
  • Growth problems
  • Easy bleeding

On rare occasions, moles can become cancerous. Any suspicious pigmented lesion should be examined by a physician and either closely observed or removed.

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Birthmarks are usually diagnosed based on the appearance of the skin area. If there is any question of the diagnosis, a biopsy may be taken for laboratory examination and you may be referred to a dermatologist, a doctor who specializes in skin disorders.

Treatment

Most birthmarks can and should be left alone. Treatment is generally recommended if the birthmark is:

  • Cosmetically undesirable and unlikely to resolve on its own
  • Causing discomfort or complications
  • Has the potential to develop into a more serious condition (rare)

Treatment options include the following:

Corticosteroid medications—A type of anti-inflammatory medication that can be given orally (by mouth) or locally injected (preferred). It is the most common treatment for rapidly growing hemangiomas. However, corticosteroid medications are for long-term use and, if given orally, have a number of risks including poor growth in children and elevated blood sugar.

Laser therapy—Lasers can be used to prevent growth of hemangiomas and to remove hemangiomas and port-wine stains.

Surgery—May be used to remove a pigmented lesion (eg, a mole) or remove residual scars left behind from other treatments.

Cosmetic alternatives—There are many make-up products that effectively cover up birthmarks. These are sometimes referred to as corrective cosmetics and include concealers, neutralizers, and camouflage products.

Regular check-ups with your primary care doctor or dermatologist are important for lesions undergoing treatment or observation.

Prevention

There is nothing that you can do to prevent birthmarks. Birthmarks are congenital (something with which you are born) and apparent at birth or by the first few weeks of life.

RESOURCES:

American Academy of Dermatology
http://www.aad.org

The Sturge–Weber Foundation (SWF)
http://www.sturge-weber.com

Vascular Birthmark Foundation
http://www.birthmark.org

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org

Canadian Vascular Birthmarks
http://www.canadianvascularbirthmarks.com

References:

Cosmetic alternatives to birthmarks. Vascular Birthmark Foundation website. Available at: http://www.birthmark.org/cosmetic.php . Accessed August 16, 2005.

Guttman C. Clinical, molecular features aid worrisome birthmark recognition. Dermatology Times . April 2005;26(4):66-67.

Hemangioma information. Vascular Birthmark Foundation website. Available at: http://www.birthmark.org/hemangiomas.php . Accessed August 16, 2005.

Mongolian blue spots. Medline Plus. US National Library of Medicine of the National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001472.htm . Accessed August 18, 2005.

Run, spot, run! American Academy of Dermatology website. Available at: http://www.aad.org/public/Parentskids/KidsConnection/KCRunSpotRun.htm . Accessed on August 16, 2005.

Strawberry hemangioma. Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?ObjectID=A71EAE4D-E0FE-4BE9-AC8C585B0146E35C . Accessed August 16, 2005.

Vascular birthmarks. American Academy of Dermatology website. Available at: http://www.aad.org/public/Publications/pamphlets/VascularBirthmarks.htm . Accessed August 16, 2005.



Last reviewed January 2008 by Ross Zeltser, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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