Birthmarks

A birthmark often develops at birth or in the first few weeks, or months, following birth. More than 80% of babies have a birthmark although this usually disappears over time. However some babies continue to have a birthmark for the rest of their life. There are two types of birthmark:

• Pigmented birthmarks
• Vascular birthmarks

Pigmented birthmarks occur from an irregular development of pigment cells. These are black, brown or grey in colour.

Vascular birthmarks develop when blood vessels collect near the surface of the skin. These are pink, red or a bluish colour. This colour depends upon how deeply rooted the blood vessels are.

Types of birthmarks

You have probably seen a few types of birthmarks, usually on adults which are spread across their face. These are often the ‘port wine stain’ or ‘strawberry’ type of birthmark. But birthmarks develop in all shapes and sizes and on various parts of the body. So what types of birthmarks develop on babies?

These include:

• Café au lait spots: these spots are oval and light brown or coffee coloured - hence the name and appear in clusters. They occur at birth or in the first few weeks following birth and affect around 50% of babies. These may fade as the baby gets older but they often darken due to sun exposure.
• Vascular stains: these are pink or purple irregular shaped marks which occur near the surface of the skin. They develop on the forehead, eyelids, back of the neck or the knee. Other names for this birthmark include ‘salmon patch’, ‘stork bites’ and ‘angel’s kiss’. This is the most common type of birthmark which occurs in 70% of babies.
• Moles: also known as ‘birthmark moles’. Small, black or brown spots which can develop at birth or childhood. Moles are discussed further in an individual section.
• Mongolian spots: Bluish or greyish coloured areas of pigment which usually occur in African or Asian babies. This takes the form of a large birthmark which develops across the lower back or buttocks. They often fade once the child starts school but never disappear completely.
• Port wine stain: A large area of pink or purple coloured skin which usually develops on the head or face although it can appear on the body. A lighter coloured port wine stain may fade but most remain and increase in size as the child gets older. Some port wine stains thicken and darken in colour over time.
• Strawberry birthmark: a large pink or reddish raised area of skin which occurs in 2 to 5% of babies. This usually increases in size but then disappears after a period of time. Also known as a ‘strawberry hemangioma’.
• Hemangiomas: the name given to a type of birthmark which is comprised of a growth of blood vessels. This growth can be flat or raised, large or small and noticeable or hardly noticeable. They usually develop on the face or neck and rather rapidly. They occur in the first few weeks following birth and continue to grow throughout the first year. They stop growing after this period of time, turn white in colour and shrink in size. This process can take several years to complete and can leave permanent changes to the skin. One type of hemangioma is the ‘strawberry birthmark’ which is discussed above. The darker variety of hemangioma is a large area of bluish-red skin which also grows rapidly but disappears once the child reaches his/her teens.

Most birthmarks disappear over time but some remain for the rest of the person’s life. Once the child is older he/she may decide to have this removed for cosmetic reasons. Treatment options include surgery, laser therapy or steroid creams/tablets/injections.

Treatment of birthmarks

The majority of birthmarks are harmless and usually disappear in childhood. But some birthmarks remain with the child through the rest of their life which they may find difficult to deal with. This is likely to be more of a problem once they reach their teens as young people are often self-conscious about their appearance.

The issue here is that of removing the birthmark. Your child’s birthmark may be large and extensive to the point where it is causing them a great deal of embarrassment and distress. Your child may be teased or bullied because of this which can make matters worse. A small birthmark on the neck is less of an issue than a large, strawberry coloured blotch on the face.

Treatment options include:

• Laser therapy
• Surgery
• Topical (applied to the skin) steroids
• Oral steroids
• Injectable steroids

But there is a risk of scarring if surgery is performed to remove a birthmark. The risks of any treatment for removing a birthmark will be discussed with you by your GP and surgeon.

Complications of birthmarks

Most birthmarks don’t cause any problems but there are a few cases in which a birthmark can be an indicator of an underlying condition or may cause further problems.

These include:

• Port wine stains near the eye can be linked to conditions such as glaucoma or seizures.
• Large hemangiomas can spread to the extent that they affect the baby’s/child’s ability to eat or breath. In some cases they can develop inside the body which can be a threat to an internal organ.
• Birthmarks on the lower back can develop deeper under the skin and affect the blood supply to the spinal cord.
• Very large moles which have appeared at birth have an increased risk of becoming cancerous.
• A large group of café au lait spots (6 or more) can be a sign of a genetic disorder called ‘neurofibromatosis type 1 (NF-1)’.

Some children experience psychological trauma later on in life from a large and particularly disfiguring birthmark.

If your baby has noticeable birthmarks or a large blotchy mark on their face then you may decide to visit your GP to see if this can be treated.

This is entirely understandable. However, your GP may advise you to wait until your baby is older and has started school as many birthmarks fade by this time. But if he/she feels that they are problematic or the sign of something more serious then he/she will recommend a course of treatment.