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What are birthmarks?
Birthmarks are areas of discolored skin that are on a child's body at birth or that show up within a few months after delivery. Over 80 percent of babies have some kind of birthmark. Some last for life, while others fade away.
Most birthmarks fall into one of two categories: vascular or pigmented. Vascular birthmarks are caused by blood vessels below the surface of the skin. They range in color from pink to red to bluish, depending on the depth of the blood vessels. Pigmented birthmarks – usually brown, gray, bluish, or black – result from an abnormal development of pigment cells.
What do they look like and which ones are most common?
Birthmarks come in a wide range of shapes, sizes, and colors, and they can show up anywhere on the body. Some birthmarks are referred to as nevi ("nevus" is the singular). The most common varieties are:
- "Stork bites," "angel kisses," salmon patches, and vascular stains: Blotchy pink or purple flat marks that are formed by dilated capillaries near the surface of the skin. This is the most common type of birthmark, with up to 70 percent of babies having one or more. These birthmarks can become more noticeable when your baby cries or when there's a change in temperature. The ones on the back of the neck, called stork bites, usually last into adulthood. The ones on the forehead or eyelids, called angel kisses, usually go away by age 2.
- Café au lait spots: Tan or light brown flat patches that sometimes appear in multiples. Between 20 and 50 percent of newborns have one or two of these pigmented birthmarks. They usually fade or get smaller as a child grows, although they may darken with sun exposure.
- Moles: Clusters of pigment-making skin cells. Moles vary in size and may be flat or raised, black or brown, hairy or not. Many moles don't show up until a child is a few years old. About 1 percent of babies have moles that are present at birth, which are called congenital nevi, or birthmark moles. These moles often start out flat and become slightly larger and more raised.
- Bluish or grayish Mongolian spots: Large, flat areas of extra pigment on the lower back or buttock that are most common in babies with dark skin: 95 to 100 percent of Asian, 90 to 95 percent of East African, 85 to 90 percent of Native American, and 50 to 70 percent of Hispanic babies have them. (Only 1 to 10 percent of Caucasian babies do.) Mongolian spots usually fade by school age, although they may never disappear.
- Port-wine stains, or nevus flammeus: Present at birth, these vascular birthmarks range from pale pink to dark purple and can appear anywhere on the body, although they show up most often on the face or head. About 1 in 300 infants is born with a port-wine stain. Light port-wine stains might fade, but most endure and get bigger as the child grows. Sometimes port-wine stains can thicken and darken (the birthmark on former Russian president Mikhail Gorbachev's head is one example). They can also form cobblestones, or small lumps, on the surface of the skin over the course of decades.
- Hemangioma: This term is used to describe a variety of growths composed of blood-vessel cells. These flat or raised lesions can be small and not very noticeable or large and disfiguring. Hemangiomas affect about 2 to 5 percent of babies and are more common in girls, preemies, and twins. Twenty percent of children who have hemangiomas have more than one.
Hemangiomas occur mostly on the head and neck, and, unlike other birthmarks, they can grow rapidly. They typically show up during the first six weeks of life – only 30 percent are visible at birth – and grow for about a year, usually getting no bigger than 2 or 3 inches. Then, without treatment, they usually stop growing and begin to turn white and shrink. This reversal process can take three to 10 years. While many hemangiomas leave normal-looking skin in their wake, others can cause permanent skin changes.
One type of hemangioma, a superficial hemangioma (formerly called a strawberry hemangioma), appears on 2 to 5 percent of babies. This raised pink-red mark tends to grow and then disappear – half are flat by age 5, and 90 percent are flat by age 9. A deeper hemangioma (formerly called a cavernous hemangioma) appears as a lumpy bluish-red mass. It grows quickly in the first six months and is usually gone by the time a child reaches her teens. Such hemangiomas are bluish in color because the abnormal vessels are deeper than those in the superficial hemangioma.
See what some of the most common birthmarks look like.
Do birthmarks require medical attention?
According to dermatologist Seth Orlow, professor of pediatric dermatology at New York University School of Medicine, most birthmarks are harmless, and many go away on their own in the first few years of life.
There are a few exceptions. In fact, 40,000 U.S. children a year have birthmarks that need medical attention. So, it's important to have your child's healthcare provider take a look at all of your child's birthmarks. Potential problems include:
- Port-wine stains near the eye and cheek are sometimes associated with vision problems like glaucoma, or with developmental delay. (This is known as Sturge-Weber syndrome.)
- Large hemangiomas, depending on where they're located, can interfere with eating, seeing, or breathing. Hemangiomas can sometimes grow internally, threatening the health of an organ. Others can be cosmetically disfiguring.
- Birthmarks on the lower spine may extend beneath the skin and affect the nerves and blood flow to the spinal cord.
- Groups of six or more café au lait spots may be a sign of a genetic disorder called neurofibromatosis type 1 (NF1). Children with NF1 usually have the spots at birth or by age 2, although the number of spots may increase in childhood and occasionally later in life. About 50 percent of people with NF1 also have learning disabilities.
- Certain especially large moles that are present at birth have an increased risk of eventually becoming cancerous.
- Some prominent or disfiguring birthmarks can become psychologically damaging to a child over time.
Can my child's birthmark be removed?
It depends. Some of the birthmarks mentioned above (like a hemangioma pushing on the eye) may require removal.
For others, the decision is controversial. Because so many birthmarks fade on their own without causing any physical problems, your child's doctor may suggest patience rather than treatment if a birthmark isn't disfiguring or causing physical problems. Some experts have challenged this wait-and-see approach, though, arguing that early intervention to treat certain birthmarks can be helpful because enough of them don't go away on their own.
If your child has a disturbing birthmark, talk with his doctor (and get a second opinion, if necessary) about options for treatment.
Depending on the birthmark, treatment options include surgery, laser therapy, and (in the case of certain hemangiomas) topical, oral, or injected steroids or topical or oral beta-blockers. Orlow says that almost all surgical birthmark-removal treatments can cause some scarring.
While port-wine stains could not be treated in the past, the introduction of the first pulsed-dye laser 25 years ago revolutionized the management of these birthmarks, especially on the face.
How can I help my child deal with the embarrassment of a disfiguring birthmark?
The best way to handle strangers – and family and friends – who may stare or make insensitive remarks about your child's birthmark is to talk to them directly.
Most people don't mean to be insensitive. If you notice someone pointing or staring at your child, you might approach the person in a friendly manner and explain that your child has a birthmark.
When you think your child is old enough to understand, explain to her what a birthmark is, why others are interested in it, and how she might cope with comments. Help her practice what she wants to say. ("It's a birthmark that I was born with.")
If she's heading to daycare, preschool, or school, talk with the staff beforehand to give them information about birthmarks and a heads-up about your child's feelings about her appearance.
What can I do to become more accepting of this situation?
Coming to terms with your child's birthmark, especially one that's large or disfiguring, can be a tall order. Find out all you can about the type of birthmark it is, so you'll feel better able to discuss it with your child's healthcare provider. You may also find it helpful to talk with other parents who are grappling with the same thing.
For more birthmark information and referrals, visit the American Academy of Dermatology or the Vascular Birthmarks Foundation websites.