A birthmark, or naevus, is a pigmented area of the skin that
is present at birth and often gets larger and darker during a child’s early
years. Birthmarks can occur anywhere on the body, although some types, such as
port wine stains and salmon patches, are more common on the face and neck.
Other types of birthmark, such as haemangiomas, may even occur inside the body.
The causes of birthmarks are unknown and most are harmless
and do not require treatment.
Types of birthmark
Birthmarks can be divided into two categories: those that
occur as a result of abnormal pigmentation, and those that are caused by blood
vessel abnormalities.
Pigmentation birthmarks include:
- Café-au-lait birthmarks: the common
coffee coloured shapes seen on the skin.
- Congenital melanocytic naevi (CMN): dark
brown or black moles.
Vascular birthmarks include:
- Haemangiomas: raised red or purple
marks on the skin that get progressively larger during the early years.
- Port wine stains: flat red or purple
stains on the skin surface that darken with age, especially during
puberty.
- Salmon patches: also known as stork
marks, these are light pink patches on the face and neck that fade quickly
in the first few months of life.
Do pigmented
birthmarks need treatment?
Pigmented birthmarks are common and rarely cause any
problems. However, a child with a significant number of café-au-lait birthmarks
should be checked for a genetic condition called neurofibromatosis.
There is a small risk that congenital melanocytic naevi birthmarks
could develop into a melanoma, a type of skin cancer, so they should be monitored
regularly for any changes of size, shape or colour. If a congenital melanocytic
naevi birthmark is causing physical or cosmetic problems, it is often possible
to remove the birthmark surgically.
Treating haemangioma
birthmarks
Although haemangioma birthmarks will grow rapidly for the
first few months, many will then fade away of their own accord, and don’t need
treatment. Around a third will be gone by the age of three, rising to more than
two thirds by the age of seven. If the original haemangioma was particularly
large, it may leave behind an area of excess skin, although this too usually
fades as the child grows. In rare cases, plastic surgery may be needed to
correct skin problems that persist.
Occasionally, the haemangioma will require treatment. A
child with a haemangioma close to the mouth, nose or throat can cause problems
with breathing or feeding, for example. In this case, it the size of the
birthmark can be reduced using drugs, such as the beta-blocker propranolol, or
laser treatment to shrink its blood vessels.
Around 17% of haemangiomas occur inside the body, usually in
the intestines, liver, lungs or brain; overall these are very rare but they can
cause serious health complications. Specialist assessment, diagnosis and
treatment is important.
Treatment for port
wine stain birthmarks
It is rare for this type of birthmark to cause a physical
problem, but a port wine stain can cause significant emotional and
psychological issues, especially if it is prominent on the face. Rarely a port
wine stain birthmark may cause pressure on the eyeball, causing glaucoma, and
in exceptional cases may lead to Sturge-Weber syndrome. This can affect both
the eyes and brain.
Port wine stain birthmarks will darken with age and so early
treatment can often achieve the best results. The primary treatment is pulsed
dye laser treatment. This sends laser energy into the small blood vessels just below
the surface of the skin. The laser heats the vessels, destroying them and so
fades the birthmark. Laser treatment for birthmarks can be performed under
local anaesthetic, but younger children may need a general anaesthetic.
Up to ten treatments may be needed, depending on how large
and dark the birthmark is. Laser treatment for birthmarks is also often not a
permanent solution, with the stain coming back after a few years. Laser
treatment can then be repeated as required.
Salmon patches or
stork marks
Around half of us are born with some form of salmon patch
birthmark and these will generally fade without treatment and pose no risk to
health. Salmon patch birthmarks can be distressing to parents as they are most
noticeable when their baby is upset or crying, due to the extra blood flowing
through the skin.
Living with
birthmarks
Whether your child’s birthmark needs to be treated or not,
it is important to support them to be confident about how they look. Many
children with birthmarks are susceptible to teasing and the negative
perceptions of others. There are many support groups available, both locally
and online, where parents share their experiences and these are good sources of
advice to help you deal with these issues.
Special make-up is also available to camouflage birthmarks
until they fade naturally or until treatment begins to take effect. These can
go a long way to helping your child to feel normal and be accepted by their
peers. The Red Cross runs specialist clinics that are very useful for finding
out more.
