Many babies are born with “birthmarks,” or develop them within the first few weeks of life. In fact, more than 10 in 100 babies have vascular birthmarks which can be flat or raised, brown, tan, pink, red, or bluish in color and are really an increase number of blood vessels in the skin.
What causes birthmarks?
The exact cause of birthmarks is unknown. Vascular birthmarks are not inherited, nor are they caused by anything that happened to the mother during pregnancy.
What are the different types of vascular birthmarks?
Some birthmarks must be watched for several weeks or months before the specific type can be identified. The most common types of vascular birthmarks are macular (flat) stains, hemangiomas, and port-wine stains. There are also some very rare types of vascular birthmarks and ones associated with inherited disorders.
The most common type of vascular birthmark is called a macular stain. When they are located on the forehead, eyelids, nose, or upper lip, they are called “angel’s kisses,” and when they are on the back of the neck, they are called “stork bite.” Macular stains are faint in color, usually mild red or pink, and flat. Angel’s kisses almost always go away by age two, but stork bites usually persist in 25% of adults. Macular stains are harmless birthmarks and require no treatment.
Hemangiomas are another common type of vascular birthmark. Typically, these do not appear immediately at birth, but become visible within the first few weeks of life. Hemangiomas are usually divided into two types: superficial (formerly called “strawberry” hemangiomas) and deep (formerly called “cavernous” hemangiomas).
A superficial hemangioma is raised and bright red because the abnormal blood vessels are very close to the surface of the skin. Hemangiomas are more common in females and in premature babies. They are usually located on the head and neck, but can appear anywhere on the body. In very rare cases, an infant may have more than one or develop an internal hemangioma.
Unlike other vascular birthmarks, hemangiomas usually grow very rapidly. Growth generally begins during the first six weeks of life and continues for about six months to one year. Usually, hemangiomas never get bigger than two or three inches in diameter, but some may be larger. After the first year, most hemangiomas will stop growing, being to turn white, and slowly shrink. Many will completely disappear during this time but often leave a faint mark. Half of all hemangiomas will be flat by age five. Nine out of ten are flat by age nine. It is impossible to know how big any hemangioma will grow, or if it will vanish.
Complications of Hemangiomas
Occasionally, a hemangioma, which is growing rapidly, can form an open sore or ulcer. These sores are often painful and can be infected. It is very important to see a dermatologist and keep the ulcer clean and covered with an antibiotic ointment and/or dressing.
A hemangioma located over the genitals, rectum, near the eye, nose or mouth can cause special problems. These hemangiomas should be watched closely by a dermatologist who will decide if further treatment is necessary. An opthalomological examination may be required.
These birthmarks look as if they could bleed easily and parents are often concerned; however, this rarely is a problem because the blood vessels are very tiny capillaries. Bleeding usually occurs only after trauma. IF the hemangioma starts to bleed, it should be treated like any other injury by cleaning the area with soap and water or hydrogen peroxide and applying a gauze bandage. If bleeding persists, apply firm, but not constricting, pressure to the area for five or ten minutes continually. If the bleeding has not stopped at that time, call a dermatologist. A dermatologist should be notified immediately if a hemangioma grows suddenly over one or two days, or if bruises develop.
Treatment of Hemangiomas
It is very important that a baby with a vascular birthmark be examined by a dermatologist as early as possible in order for a correct diagnosis to be made and the need for treatment discussed. For example, periorbital hemangiomas may interfere with visual development; therefore, it is critical to treat quickly. Although it is not always easy for parents to watch a hemangioma grow, or to wait for the hemangioma to disappear, most hemangiomas do not require treatment. They eventually shrink by themselves leaving very few signs.
There are several different types of treatments for hemangiomas. Most of the time, the dermatologist will choose to watch the lesion. Other possibilities can be considered under certain circumstances. No treatment is absolutely safe and effective. The potential benefits of treatment must be weighed against the possible risks.
The most widely used treatment for rapidly growing hemangiomas is corticosteroid medication. This is either injected into the hemangioma or given by mouth. Long-term or repeated treatments may be necessary. These treatments may have side effects, which the dermatologist will explain.
Lasers can be used to both prevent the growth of the hemangiomas and to remove the superficial hemangiomas. Hemangiomas with sores that will not heal also can be treated with lasers. New types of lasers are being developed and studied by dermatologists to treat this condition.
Port-Wine Stains (Nevus Flammeus)
The port-wine stain is a type of vascular birthmark that occurs in 3 out of 1,000 infants. Port-wine stains appear at birth and are flat, pink, red, or have purplish discoloration. They are found most often on the face, neck, arms, or legs and can vary in size. Unlike hemangiomas, port-wine stains grow proportionately as the child grows. Over time, port-wine stains may become thick and develop small bumps or ridges. Port-wine stains are permanent.
Complications of Port-Wine Stains
Port-wine stains, especially those on the face, can have emotional, social, and economic complications. Port-wine stains on the forehead, eyelids, or both sides of the face can be associated with seizures and/or glaucoma. (Glaucoma is increased pressure within the eye, which may cause blindness.) These complications occur in less than half of those with port-wine stains of the forehead and eyelids. All infants with port-wine stains in those areas should have a thorough eye examination, and if indicated, brain imaging.
Occasionally, there may be a gradual enlargement of tissues surrounding a port-wine stain, especially if it is on the arm or leg. Children with large port-wine stains should be monitored for any growth problems.
With time, port-wine stains can develop small blood vessel growths called vascular blebs. These can bleed easily and should be removed.
Treatment of Port-Wine Stains
Various methods have been tried in the past to remove port-wine stains, but none have worked well. Laser treatment of port-wine stains I FDA-approved and available at many dermatologists’ offices. Several treatments given at two-month intervals, are usually required. These lighten the vascular mark 50-90 percent. In a small number of patients, lasers can clear the port-wine stain completely. The newer types of vascular lasers provide the best results with the least amount of risk and side effects.
There are several risks of laser therapy. An increase or decrease in skin color can occur leaving a patchy skin tone or whitening of the skin. In most cases, this is not permanent. Swelling, crusting, or minor bleeding can occur. This is unusual and can be treated easily. Permanent scarring occurs in a small number of patients. Laser therapy is uncomfortable, but not extremely painful. General anesthesia is often necessary for toddlers and young children, but there are possible risks associated with general anesthesia. Adults may us topical anesthesia (a cream applied to the area).
The use of cover-up makep has been a common way to manage port-wine stains. The dermatologist can provide more information about products that are made to cover up birthmarks.
Most vascular birthmarks disappear without treatment or can be treated effectively. Through research, dermatologists are learning more about the causes and treatments of all types of vascular birthmarks. For more information, contact your dermatologist or consult the links to the right of this page.