Many babies have what are called "birthmarks", marks on the skin when they are born or that develop in a few weeks. More than one in ten babies have red marks called vascular birthmarks as the result of an increased number of blood vessels in that area of the skin.
The exact cause of birthmarks is unknown. However, vascular birthmarks are not inherited or caused by anything that happened during pregnancy.
Types of vascular birthmarks
Though there are a number of different types of vascular birthmarks, some very rare, the three most common types are macular (flat) stains, hemangiomas and port-wine stains.
Macular stains: The most common type of vascular birthmark is a flat, mild red or pink mark called a macular stain. These birthmarks are commonly called "angel kisses" when found on the forehead, eyelids, nose or upper lip and "stork bites" when on the back of the neck. Angel kisses almost always go away by age two, but stork bites usually persist into adult.Macular stains are harmless and require no treatment.
Hemangiomas: Hemangiomas are a common type of birthmark that usually appears within the first few weeks of life. There are two types of hemangiomas, superficial (once called "strawberry") and deep. Superficial hemangiomas are raised and bright red because the abnormal blood vessels are close to the skin surface. Deep hemangiomas are bluish-purple because the abnormal blood vessels are deeper under the skin. Though they can appear anywhere, hemangiomas are more common on the head and neck. They are also more common in females and premature babies.
Unlike other vascular birthmarks, hemangiomas usually grow very rapidly from in the first six weeks of life until about six months to one year. Most never grow bigger than two to three inches. When the growth stops, they turn white and begin to shrink. Half of all hemangiomas are flat by age five with 90 percent flat by age nine. Many disappear completely or leave a very faint mark.
Though most hemangiomas cause no problems, the following complications can occur:
Open sore or ulcers: If painful sores form, see your dermatologist, keep the sore clean and covered and apply antibiotic ointment to help prevent infection.
Hemangiomas located on the genital or rectum, near an eye, the nose or mouth: These can cause special problems which should be watched by a dermatologist and treated if necessary.
Bleeding: Though hemangiomas often look like they could bleed easily, this is rarely a problem and usually only occurs after injury. Treat any bleeding by cleaning the area with soap and water or hydrogen peroxide and applying a gauze bandage. Apply firm pressure for five to ten minutes to stop the bleeding and call your dermatologist if it does not stop.
Sudden growth: Rarely, a hemangioma will grow suddenly over one or two days. Contact your dermatologist immediately if this occurs or if bruises begin to develop.
Treatment of hemangiomas
Though a growing hemangioma may seem alarming to parents, almost all hemangiomas go away by themselves without treatment. For this reason, your dermatologist will usually recommend simply watching the lesion. Treatment is only considered under certain circumstances. Because no treatment option is absolutely safe and effective, the potential benefits of any treatment should be weighed carefully against possible risks.
Rapidly growing hemangiomas may be treated with corticosteroid mediation, either injected into the hemangioma or taken by mouth. Long-term or repeated treatments may be necessary. Corticosteroids may have side effects that should be discussed with your dermatologist.
Lasers can be used to prevent growth of hemangiomas, to remove superficial hemangiomas or to treat sores that will not heal.
Port Wine Stains
Port-wine stains are flat, pink, red or purplish discolorations that appear at birth in 3 of every 1000 infants. They are most often found on the face, neck, arms or legs and can be any size. Port-wine stains are permanent and grow proportionately as the child grows. Over time, they may become thick and develop small bumps or ridges.
Though most complications are not common, port wine stains may be associated with the following:
Emotional, social and economic complications can occur in patients with port-wine stains, especially on the face.
Port-wine stains on the forehead, eyelids or both sides of the face can be associated with seizures and/or glaucoma, an eye disease that left untreated can cause blindness. All infants with a port-wine stain in these areas should have a thorough eye examination and brain imaging, if indicated
Occasionally, very gradual enlargement of tissue surrounding a port-wine stain occurs, especially when the birthmark is on an arm or leg. All children with large port-wine stains should be monitored for problems.
Small blood vessel growth called vascular blebs can develop over time. These can bleed easily and may be removed.
Treatment of port-wine stains
Using make-up to cover port-wine stains is a common treatment. Your dermatologist can recommend products made to effectively cover birthmarks.
Though various methods to remove port-wine stains have been tried in the past, most have been less than effective. However, new types of vascular lasers have shown good results with fewer risks and side effects. Laser treatment of port-wine stains is FDA-approved and available as an outpatient procedure at your dermatologist's office. Several treatments given at two month intervals are usually required. Laser treatments can lighten the mark by 50 to 90 percent in most patients.
Though laser treatments are generally safe and effective, there are risks which you should discuss with your dermatologist. In addition, laser treatment can be uncomfortable, though not extremely painful. In adults, topical anesthesia may be used to relieve discomfort. However, toddlers and young children may require general anesthesia (putting the child to sleep), which carries some additional risks and higher costs.
All babies with a vascular birthmark should be examined by a board certified dermatologist to accurately identify the type of birthmark and discuss the need for treatment, if any. Remember, most vascular birthmarks go away without treatment or can be treated effectively.