Birthmarks
Overview
What are birthmarks?
There are two main categories of birthmarks — red birthmarks and pigmented birthmarks. Red birthmarks are a vascular (blood vessel) type of birthmark. Pigmented birthmarks are areas in which the color of the birthmark is different from the color of the rest of the skin.
What are red birthmarks?
Red birthmarks are colored, vascular (blood vessel) skin markings that develop before or shortly after birth. Red birthmarks are caused by an overgrowth of blood vessels.
What are the types of red birthmarks?
One common kind of vascular birthmark is the hemangioma. It usually is painless and harmless and its cause is unknown. Color from the birthmark comes from the extensive development of blood vessels at the site.
Strawberry hemangiomas (strawberry mark, nevus vascularis, capillary hemangioma, hemangioma simplex) might appear anywhere on the body, but are most common on the face, scalp, back, or chest. They consist of small, closely packed blood vessels. They might be absent at birth, and develop after several weeks. They usually grow rapidly, remain a fixed size, and then subside. In most cases, strawberry hemangiomas disappear by the time a child is 9 years old. Some slight discoloration or puckering of the skin might remain at the site of the hemangioma.
Cavernous hemangiomas (angioma cavernosum, cavernoma) are similar to strawberry hemangiomas but are more deeply situated. They might appear as a red-blue spongy mass of tissue filled with blood. Some of these lesions disappear on their own, usually as a child approaches school age.
Port-wine stains are flat, purple-to-red birthmarks made of dilated blood capillaries. These birthmarks occur most often on the face and might vary in size. Port-wine stains often are permanent (unless treated) and might thicken or darken over time, resulting in emotional distress.
Salmon patches (also called stork bites) appear on 30 percent to 50 percent of newborn babies. These marks are small blood vessels (capillaries) that are visible through the skin. They are most common on the forehead, eyelids, upper lip, between the eyebrows, and the back of the neck. Often, these marks fade as the infant grows.
What are pigmented birthmarks?
Pigmented birthmarks are skin markings that are present at birth. The marks might range from brown or black to bluish, or blue-gray in color.
What are the types of pigmented birthmarks?
Mongolian spots are usually 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.
Pigmented nevi (moles) are growths on the skin that usually are flesh-colored, brown, or black. Moles can appear anywhere on the skin, alone or in groups.
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 healthcare 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.
Symptoms and Causes
What causes pigmented birthmarks?
The cause of pigmented birthmarks is not known. However, the amount and location of melanin (a substance that determines skin color) determines the color of pigmented birthmarks. 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). Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. These cells are called melanocytes, and they make the pigment that gives skin its natural color. Moles might darken after exposure to the sun, during the teen years, and during pregnancy.
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
- Skin markings that resemble blood vessels
- Possible bleeding
- Skin that might break open
Diagnosis and Tests
How are red birthmarks diagnosed?
In most cases, a healthcare professional can diagnose a red birthmark based on the appearance of the skin. Deeper birthmarks can be confirmed with imaging tests such as MRI, ultrasound, CT scans, or biopsies.
How are pigmented birthmarks diagnosed?
In most cases, healthcare professionals can diagnose birthmarks based on the appearance of the skin. If needed, a skin biopsy might be performed.
Management and Treatment
How are pigmented birthmarks treated?
In most cases, no treatment is needed for the birthmarks themselves. When birthmarks do require treatment, however, that treatment varies based on the kind of birthmark and its related conditions.
Large or prominent nevi that affect the appearance and self-esteem might be covered with special cosmetics.
Moles might be removed surgically if they affect the appearance or if they have an increased cancer risk.
What is the treatment for red birthmarks?
Many capillary birthmarks such as salmon patches and strawberry hemangiomas are temporary and require no treatment. For permanent lesions, concealing cosmetics might be helpful. Cortisone (oral or injected) can reduce the size of a hemangioma that is growing rapidly and obstructing vision or vital structures. Other oral medicines have been used experimentally with some success in these cases, as well.
Port-wine stains on the face can be treated at a young age with a yellow-pulsed dye laser for best results. Treatment of the birthmarks might help prevent psychosocial problems that can result in individuals who have port-wine stains.
Permanent red birthmarks might be treated with methods including:
- Cryotherapy (freezing)
- Laser surgery
- Surgical removal
In some cases, birthmarks are not treated until a child reaches school age. However, birthmarks are treated earlier if they result in unwanted symptoms or if they compromise vital functions such as vision or breathing.
Prevention
Can red birthmarks be prevented?
Currently, there is no known way to prevent red birthmarks.
Can pigmented birthmarks be prevented?
There is no known way to prevent birthmarks. People with birthmarks should use a good quality sunscreen when outdoors in order to prevent complications.
Living With
What are the complications of pigmented birthmarks?
Some complications of pigmented birthmarks can include psychological effects in cases in which the birthmark is prominent. Pigmented birthmarks also can pose an increased skin cancer risk.
A doctor should check any changes that occur in the color, size, or texture of a nevus or other skin lesion. See a doctor right away if there is any pain, bleeding, itching, inflammation, or ulceration of a congenital nevus or other skin lesion.
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