What are birthmarks?

A birthmark is a skin marking which is present at birth or appears shortly after birth, usually within the first two months of life. Dermatologists divide birthmarks into two main categories—vascular “red” birthmarks and pigmented birthmarks.

What are pigmented birthmarks?

Pigmented birthmarks are areas in which the color of the birthmark is different from the color of the rest of the skin. The marks range in color from tan, brown, black, blue, or blue-grey.

What are the types of pigmented birthmarks?

Mongolian spots are usually are bluish and look like bruises. They often appear on the buttocks and/or lower back, but they sometimes also appear on the trunk or arms. These spots are seen most often in people who have darker skin.

Congenital nevi are moles that are present at birth. About 1 in 100 people are born with one or more moles. These birthmarks have a slightly increased risk of becoming skin cancer, depending on their size. Larger congenital nevi (>20 cm) have a greater risk of developing into skin cancer than do smaller congenital nevi. All congenital nevi should be examined by a health care provider, and any change in the birthmark should be reported.

Cafe-au-lait spots are light tan or light brown spots that are usually oval in shape. They usually appear at birth but might develop in the first few years of a child’s life. Cafe-au-lait spots might be a normal type of birthmark, but the presence of several cafe-au-lait spots larger than a quarter might occur in neurofibromatosis (a genetic disorder that causes abnormal cell growth of nerve tissues) and other conditions.

What are vascular “red” birthmarks?

Red birthmarks are a caused by an overgrowth of blood vessels.

What are some common types of vascular “red” birthmarks?

There are many different kinds of vascular birthmarks, but the three most common types are macular stains, hemangiomas, and port wine stains. The different types of birthmarks have their own appearance and typical locations that are usually affected. Brief descriptions of these common types are discussed below.

Macular stains

Also called “salmon patches”, this is the most common type of vascular birthmark. They are faint, mild red or pink in color, and flat. They are commonly called “angel’s kisses” when they are located on the forehead, eyelids, tip of the nose, or upper lip or “stork bites” on the back of the neck. Stork bites appear on 30 to 50 percent of newborn babies and usually persist into adulthood, but are often covered by hair once it grows in as the child ages. Angel’s kisses most often fade as the infant grows and will go away by age two.


Hemangiomas are usually divided into two types based on how extensive the development of blood vessels at the site is underneath the skin: superficial hemangiomas (strawberry hemangiomas, strawberry mark, nevus vascularis, capillary hemangioma, hemangioma simplex) and deep hemangiomas (cavernous hemangioma angioma cavernosum, cavernoma).

Superficial hemangiomas tend to be raised and bright red in color because the abnormal blood vessels are very close to the surface of the skin, whereas deep hemangiomas tend to be bluish-purple in color because the abnormal blood vessels are deeper under the skin. They might be absent at birth, and develop after several weeks, and are more common in females, multiple gestations like twins, and premature babies. Usually a baby will have only one hemangioma, but in very rare cases, an infant may have many or even some internally.

Unlike the other types of vascular birthmarks, hemangiomas typically grow very rapidly for several months, then they become white-grey in color and slowly shrink in most cases. Fifty percent of all hemangiomas are flat by age 5, and about 90% are flat by age 9.

It is impossible to predict how big any hemangioma will grow, or if it will completely disappear. Some slight discoloration or puckering of the skin might remain at the site of the hemangioma.

Port-wine stains

Port-wine stains are flat, purple-to-red birthmarks made of dilated blood capillaries that appear at birth. These birthmarks occur most often on the face and might vary in size. Port-wine stains often are permanent (unless treated) and might thicken, develop small bumps or ridges, or darken over time. Rarely, port-wine stains on the forehead, eyes, or both sides of the face can be associated with glaucoma and/or seizures. Those children should be evaluated by a physician to monitor for those complications.

What causes pigmented birthmarks?

The cause of pigmented birthmarks is not known.

What are the symptoms of pigmented birthmarks?

Pigmented birthmarks might increase in size as the child grows, change colors (especially after sun exposure and during the teen years as hormone levels change), become itchy, and might occasionally bleed.

What are the symptoms of red birthmarks?

Symptoms of red birthmarks include:

  • Skin markings that develop before or shortly after birth
  • Red skin rashes or lesions - may be more noticeable when the infant cries or during temperature changes
  • Itching
  • Open sore or ulcer
  • Possible bleeding

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