Birthmarks

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Birthmarks

Topic Overview

What are birthmarks?

A birthmark is a coloured mark on or under a newborn baby’s skin. Some birthmarks show up soon after a baby is born. Most birthmarks are obvious at birth. Some kinds of birthmarks fade or go away as a child gets older. Others stay the same or get bigger, darker, or thicker.

There are many kinds of birthmarks. They can be any size or shape and can be different colours, such as blue or blue-grey, brown, tan, black, pink, white, red, or purple. Some birthmarks are smooth, and some are raised.

Nearly all birthmarks are harmless and painless. But it’s important to have a doctor check all birthmarks, just to be sure they are okay.

What causes birthmarks?

Some birthmarks are from extra colour (pigment) in the skin. Other birthmarks are blood vessels that are bunched together or do not grow normally.

It is not clear why some children have birthmarks and others do not.

What kinds of birthmarks are there?

  • Salmon patches (also called stork bites, angel kisses, and macular stains). Salmon patches are thin, flat, light pink or red birthmarks. They tend to be on the back of the neck, the upper eyelids, upper lip, or between the eyebrows.
  • Congenital moles (nevi). Congenital moles can grow anywhere on the body. They vary in size and shape. Most are brown.
  • Café-au-lait spots. Most café-au-lait spots are smooth, oval birthmarks. They range in colour from light brown to chocolate brown and usually are found on the torso, buttocks, and legs.
  • Mongolian spots. Mongolian spots are smooth, blue or blue-grey birthmarks. They are often uneven in shape and are on the lower back and buttocks.
  • Hemangiomas. Hemangiomas are raised birthmarks. They are blue, red, or purple. They are clumps of blood vessels that did not grow normally. Hemangiomas grow in many shapes and sizes and can grow on the skin or deeper in the body.
  • Port-wine stains. Port-wine stains are birthmarks that are pink-red at birth and then become a darker red-purple. Port-wine stains are blood vessels that did not grow normally. They can be small, or they can cover a large area of the body.

Do birthmarks need to be treated?

Most birthmarks are harmless and need no treatment. Some will even fade or disappear over time. Some kinds of birthmarks can be removed with surgery or lightened with a laser. But these treatments can hurt, and they may not work. That is why most birthmarks are not treated.

Only rarely does a birthmark need to be treated because it causes a medical problem. This can be a problem with sight, breathing, hearing, speech, or movement. And birthmarks that grow rapidly, such as severe infant hemangiomas, need to be treated right away. Also, birthmarks that grow on internal organs need treatment.

Even if your child’s birthmark bothers or worries you, try not to let your child know how you feel. Ask others not to make a big deal out of it. If a birthmark upsets your child, it may help to have your child talk with a trusted doctor. If your child is still upset, talking to a counsellor or support group may be a good idea to help him or her feel better.

Is it important to have birthmarks checked?

Although most birthmarks are harmless, some are not. If you see a birthmark on your baby, make sure that a doctor has seen it. If a birthmark grows, bleeds, hurts, or gets infected, see a doctor to have it checked.

Frequently Asked Questions

Learning about birthmarks:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with birthmarks:

Symptoms

There are no symptoms of birthmarks. They simply are coloured marks on the skin. One kind of birthmark can look very different from another kind of birthmark. Birthmarks can:

  • Be flat or raised.
  • Have regular or irregular borders.
  • Be many different colours, including brown, tan, black, pale blue, blue-grey, pink, red, or purple.
  • Be smooth or lumpy.
  • Be thin lines of colour or solid colour.
  • Be only on the surface of the skin or extend into the tissues under the skin.
  • Grow quickly, remain the same size, shrink, or disappear over time.

All birthmarks need to be checked by a doctor. Most do not need treatment. Certain changes in a birthmark or certain types of birthmarks may need to be watched closely and/or treated. See a doctor if a birthmark:

  • Bleeds.
  • Develops an open sore (ulcer).
  • Becomes infected.
  • Interferes with normal functioning or vision.
  • Grows suddenly or becomes painful.

Examinations and Tests

Most birthmarks are diagnosed by a careful medical history and physical examination. Sometimes a doctor will monitor changes in a birthmark by taking photos of the birthmark over a period of time. All birthmarks need to be checked by a doctor.

If a doctor suspects that your child has other problems, he or she may do a blood test or do other tests to check your child's internal organs (liver, lungs, stomach, or intestines). Additional tests might include MRI or ultrasound. In rare cases, a doctor cuts out a piece of the birthmark (biopsy) to make a diagnosis.

Treatment Overview

Many birthmarks fade or disappear over time. Other birthmarks do not fade. Only rarely does a birthmark need treatment because it is growing rapidly or causing a medical problem with sight, breathing, hearing, speech, or movement. Birthmarks that grow on internal organs may need treatment.

There are several ways to fade, shrink, or remove some types of birthmarks. But treating can be a big decision, because treatments can be painful and don't always work.

Your baby's doctor might be able to tell you whether a birthmark will grow, shrink, or fade. This is also a good time to talk about any worries you have about a birthmark. You may find that it helps to be reassured that a birthmark is normal and painless.

Some birthmarks will shrink during a child's first year. Even a hemangioma that grows at first is likely to shrink during a child's first years of life. But babies born with severe hemangiomas that are growing rapidly need to be treated right away. There is a medicine (propranolol) that works well to treat severe infant hemangiomas.

If your child’s birthmark bothers you, try not to let your child know. Ask others not to make a big deal out of it. Focus instead on your child's many positive qualities and skills.

If a birthmark is upsetting your child, ask your child’s doctor to talk to your child about it. Getting reassurance from a doctor often helps a child. If not, a counsellor or support group may be a good way to help your child feel better.

If you or your child wants to hide a birthmark, you can try makeup or different hairstyles.

Birthmark treatments

Treatment for birthmarks can be controversial. It is important to know the benefits and risks of treatment and to understand that not all birthmarks can be treated. Ask your doctor to show you photographs of birthmarks that have been treated and photographs of birthmarks that have not been treated.

Of all the types of birthmarks, hemangiomas are the most likely to be treated. Although hemangiomas can look painful or ugly, most shrink without treatment. The type of treatment given depends on the age of the child, as well as the type, size, rate of growth, and location of the hemangioma. For example, a fast-growing hemangioma near a child's eye needs treatment, as do those that may leave big scars or affect vision. Hemangiomas on internal organs may need treatment.

Treatment for birthmarks includes:

  • Propranolol. This medicine is a beta-blocker that works quickly to soften and shrink hemangiomas. It is used to treat babies with severe hemangiomas that are growing rapidly.
  • Corticosteroids, such as prednisone. Corticosteroids can be taken as pills or injected directly into a hemangioma to shrink it or to stop it from growing. Most birthmarks treated with these medicines shrink within 2 to 4 weeks. But side effects (such as weight gain or round face) can occur.
  • Interferon alfa-12. In very rare cases, corticosteroids do not shrink or stop a hemangioma from growing. Interferon alfa-12 may then be used to reduce the size of the hemangioma. This treatment usually lasts 3 to 6 months and has serious side effects, including fever, irritability, neutropenia, and liver problems.
  • Laser therapy. Lasers are often used on birthmarks that are close to the surface of the skin, such as port-wine stains. Sometimes, laser therapy can stop a hemangioma from growing. But it may not work to treat a deeper hemangioma.
  • Surgery. Surgery is used for a hemangioma that is causing a medical problem, after other treatments have not worked. When a hemangioma is on an internal organ, it may need to be removed. Surgical removal of a hemangioma may leave a scar, which may be removed or faded with other treatments.

Birthmarks are best treated by plastic surgeons or dermatologists.

Home Treatment

Even though most birthmarks do not cause physical harm, they may make you or your child feel shy or self-conscious. Each person is different and reacts differently to a birthmark. What bothers one person may not bother another. Parents of a child with a birthmark can reduce the impact that it has on their child's life by understanding and accepting that the birthmark is normal.

If you or your child is bothered by a birthmark, talk with your doctor. There might be treatment options, makeup, or hairstyles that can hide a birthmark and/or support groups and counselling that can help.

If your child has a raised birthmark, the following may be helpful:

  • Avoid scraping or scratching it. Hemangiomas contain blood vessels that may bleed.
  • If a hemangioma becomes sore and bleeds (ulcerates), apply continuous pressure to the area with a clean pad for 10 minutes and contact your doctor for more advice.
  • Apply an antibiotic ointment to small injuries to a birthmark. If the injury is large, contact a doctor.
  • When a hemangioma starts to shrink, the skin may become soft and easily damaged by the sun or by rough treatment. Ask your doctor how to care for it.

If your child's birthmark has been treated with surgery or laser therapy, keep your child's fingernails trimmed short to prevent him or her from scratching the treated area. It also is important to keep your child out of the sun for several weeks after surgery. Until your child's treated areas are completely healed, use sunscreen on the treated areas when your child is out in the sun. For more information, see the topic Protecting Your Skin From the Sun.

Other Places To Get Help

Organization

Canadian Dermatology Association
1385 Bank Street
Suite 425
Ottawa, ON  K1H 8N4
Phone: 1-800-267-3376
(613) 738-1748
Fax: (613) 738-4695
Email: contact.cda@dermatology.ca
Web Address: www.dermatology.ca
 

The Canadian Dermatology Association promotes research and education for dermatologists, provides information and support for dermatology patients, and offers public education materials on sun awareness and skin care.


References

Other Works Consulted

  • Chang MW, Orlow SJ (2008). Neonates and infants section of Neonatal, pediatric, and adolescent dermatology. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 1, pp. 935–941. New York: McGraw-Hill.
  • Grichnik JM, et al. (2008). Congenital nevomelanocytic nevi section of Benign neoplasias and hyperplasias of melanocytes. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 1, pp. 1099–1103. New York: McGraw-Hill.
  • Horii KA, Sharma V (2010). Birthmarks section of Pediatric Dermatology. In JC Hall, ed., Sauer’s Manual of Skin Diseases, 10th ed., pp. 425–427. Philadelphia: Lippincott Williams and Wilkins.
  • Huikeshoven M, et al. (2007). Redarkening of port-wine stains 10 years after pulsed-dye-laser treatment. New England Journal of Medicine, 356(12): 1235–1240.
  • Miller JH (2010). Hemangiomas. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 289–291. Philadelphia: Mosby Elsevier.
  • Miller T, Frieden IJ (2008). Vascular tumors. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol,. 1, pp. 1164–1172. New York: McGraw-Hill.
  • Morelli JG (2007). Diseases of the neonate. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 2661–2664. Philadelphia: Saunders Elsevier.
  • Swee TT, et al. (2010). Low-dose propranolol for infantile haemangioma. Journal of Plastic, Reconstructive and Aesthetic Surgery. Published online July 9, 2010 (doi:10.1016/j.bjps.2010.06.010).

Credits

By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Alexander H. Murray, MD, FRCPC - Dermatology
Last Revised May 2, 2011

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