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.

Different types

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 them

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.

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