BirthmarksWhat are birthmarks?Birthmarks are areas of discolored skin that are on a baby's body at birth or show up within a few weeks after birth. Over 80 percent of babies have a birthmark. Some birthmarks endure for life, while others fade away over time.Birthmarks are usually grouped into one of two categories: vascular or pigmented. Vascular birthmarks result from an abnormal development of blood or lymph vessels below the surface of the skin. They range in color from pink to red to bluish, depending on the depth of the vessels. Pigmented birthmarks — usually brown, gray, bluish, or black — result from an abnormal development of pigment cells. Some birthmarks are also known as nevi ("nevus" is the singular).
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. The most common varieties are:
• 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 get smaller as a child grows, though they may also darken with sun exposure.
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Moles: Clusters of pigmented skin cells. They 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, but those that are present at birth are called congenital nevi, or birthmark moles, and about 1 percent of babies have them. These often start out flat and become slightly larger and more raised.
• Bluish or grayish Mongolian spots: Large, flat areas of extra pigment on the back or buttocks 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, 50 to 70 percent of Hispanic, and 1 to 10 percent of Caucasian babies have them. Mongolian spots usually fade by school age, though they may never disappear altogether.
• "Stork bites," "angel kisses," salmon patches, and macular stains: Blotchy pink or purple flat marks that are dilated capillary veins near the surface of the skin. They're the most common birthmark, with up to 70 percent of babies having one or more. They can become more noticeable when the 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's kisses," usually go away by age 2.
• Port-wine stains (PWS), or nevus flammeus: Dark, berry-colored stains that are present at birth. These vascular birthmarks range from pale pink to dark purple and can appear anywhere on the body, though they show up most often on the face or head. About .3 percent of infants are born with PWS. 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 an example). They can also form cobblestones, or small lumps, on the surface of the skin.
• Hemangioma: A term used to describe a variety of blood vessel growths. These raised, rough lesions can be large and disfiguring or small and not very noticeable, and they affect about 10 percent of babies. Hemangiomas occur mostly on the head and neck, and unlike other birthmarks, they can grow rapidly. They usually show up during the first six weeks of life (only 30 percent are visible at birth), and grow for about a year — usually no bigger than 2 or 3 inches. Then, without treatment, they usually stop growing, turn white, and start shrinking (this is called involution). This reverse process can take three to ten years. Twenty percent of children who have hemangiomas have more than one, and they're more common in girls, preemies, and twins.One type of hemangioma is a strawberry hemangioma, which appears on about 2 to 5 percent of babies. This raised, strawberry-red mark tends to grow and then disappear — half are flat by age 5, and nine out of ten are flat by age 9. A deeper hemangioma appears as lumpy bluish-red mass. It grows quickly in the first six months and is usually gone by the time a child reaches his teen years. Such hemangiomas are bluish in color because the abnormal vessels are deeper than those in the strawberry hemangioma.
Are they ever serious?According to dermatologist Seth Orlow, director 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, without treatment. There are a few exceptions, though. In fact, 40,000 U.S. children a year have birthmarks that need medical attention. So it's important to have all birthmarks checked out by your child's healthcare provider. Potential problems include:
• Port-wine stains near the eye and cheek are sometimes associated with vision problems like glaucoma, or with seizures and developmental delay. (This is known as Sturge-Weber Syndrome.)
• Large hemangiomas, depending on where they're located, might interfere with eating, seeing, or breathing. Sometimes hemangiomas grow internally, threatening the health of an organ.
• Birthmarks on the lower spine may extend beneath the skin and affect the nerves and blood flow.
• Groups of six or more café au lait spots may be a sign of a genetic disorder called neurofibromatoses (NF). Children with NF usually have the spots at birth or by age 2, though the number may increase in childhood and occasionally later in life. About 50 percent of people with NF also have learning disabilities.
• Certain especially large moles that are present at birth have an increased risk of eventually becoming cancerous.
• Some birthmarks can be psychologically damaging to a child over time.
Can my child's birthmark be removed?It depends. Some of the conditions mentioned above (like a hemangioma close to the eye) might require removal. If a birthmark isn't disfiguring or causing physical problems, though, it's usually best to leave it alone. Of course, a large hemangioma on your child's face can be distressing, and it's understandable if you want to do something about it now. But because most of these birthmarks will fade by the time your child's ready for school, it's unlikely your doctor will recommend any special treatment. Some experts have challenged this wait-and-see approach, though, arguing that enough of them never disappear completely, and that early intervention to treat certain birthmarks can be helpful. So you may want to get more than one opinion about treatment.
Treatment optionsTreatment options include surgery, laser therapy, and topical, oral, or injected steroids, depending on the birthmark. Orlow says that almost all birthmark-removal treatments can cause some scarring. Port-wine stains are difficult to remove completely, but laser therapy can usually make them lighter.
