Vascular Birthmarks

What Is a "Vascular Birthmark?"

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Many babies have what are called "birthmarks" when they're born or wihin the first few weeks of life. They can be brown, tan, blue, pink, or red. More than one in ten babies have (red) vascular birthmarks. These are made up of an increased number of blood vessels in the skin. They can be flat or raised, pink, red or bluish in color.

What Causes Birthmarks?

The exact causes of birthmarks are unknown. However, vascular birthmarks are not inherited, nor are they caused by anything that happens to the mother during pregnancy.

What Are the Different Types of Vascular Birthmarks?

There are different kinds of vascular birthmarks. Sometimes, the birthmark 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.
Macular Stains

The most common type of vascular birthmark that your physician may identify is called a macular stain. They are also called "angel's kisses," when they are located on the forehead, eyelids, tip of nose, or upper lip. When they are found on the back of the neck, they are frequently called "stork bites." Macular stains are faint, mild red or pink, and flat. Angel's kisses almost always go away by two years of age, but stork bites usually persist into adulthood.

These birthmarks are harmless and require no treatment.

Hemangiomas

Dermatologists prefer to use the term hemangioma to refer to a common type of vascular birthmark. These marks do not usually appear immediately at birth, but become visible within the first few weeks of life. Hemangiomas are usually divided into two types: superficial (used to be called "strawberry" hemangiomas), and deep (used to be referred to as "cavernous" hemangiomas).

A superficial hemangioma is raised and bright red because the abnormal blood vessels are very close to the surface of the skin.

Strawberry hemangioma
without treatment at 8 months

At 2.5 years

Deep hemangiomas have a bluish-purple color because the abnormal vessels are deeper under the skin (like varicose veins appear blue). Hemangiomas are more common in females, more common on the head and neck, and more common in premature babies. They can be anywhere on the body.

Usually, a baby will have only one hemangioma, but sometimes there will be two or three. In very rare cases, an infant may have many, or even some internally. 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. Most 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. They then begin to turn white and slowly shrink. Half of all hemangiomas (50%) are flat by age five. Nine out of ten (90%) are flat by age nine. Many will completely go away, but often, a faint mark is left. It's impossible to know how big any hemangioma will grow, or if it will completely disappear.

Complications of Hemangiomas

Occasionally, a hemangioma which is growing or shrinking rapidly can form an open sore or ulcer. These sores are often painful, and can become infected. It's very important to see your dermatologist and keep this ulcer clean and covered with antibiotic ointment and/or a dressing.

A hemangioma located over the genitals or rectum, near an eye, nose or mouth, can cause special problems. These hemangiomas should be watched closely by your dermatologist who will decide if further treatment is necessary.

Parents are often concerned that a hemangioma will bleed. These birthmarks do look as if they could bleed easily. However, this usually isn't a problem because the blood vessels are very tiny capillaries. Bleeding usually occurs only after injury. 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. Apply firm, but not tight, pressure on the area for five to ten minutes to stop bleeding. If the bleeding has not stopped at that time, call your dermatologist.

A hemangioma will rarely grow suddenly over one or two days. If this occurs, it's important to call your dermatologist. Also, if a bruise begins to develop, your dermatologist should be notified.

Treatment of Hemangiomas

It's very important that a baby with a vascular birthmark be examined by a dermatologist as early as possible so that a correct diagnosis can be made and the possible need for treatment discussed.

It's not always easy for parents to watch a hemangioma grow, or wait for it to disappear without doing anything. However, 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, your dermatologist will choose to watch the lesion. Other possibilities will be considered only 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 carry side effects to be discussed with your specialist.

Lasers can be used to prevent growth of hemangiomas and to remove superficial hemangiomas. Hemangiomas with sores that will not heal can also be treated with lasers. New lasers are being developed and studied by dermatologists to treat this condition.

Port-Wine Stains

The port-wine stain is another type of vascular birthmark that occurs in 3 in 1,000 infants. It is sometimes called a nevus flammeus, but it should not be confused with a hemangioma.

Port-wine stains appear at birth. They are flat, pink, red or have a purplish discoloration. Port-wine stains are found most often on the face, neck, arms or legs. They can be any 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 do not go away by themselves, and are permanent.

Port-Wine Stain
before treatment

Port-Wine Stain
after treatment

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 glaucoma and/or seizures. Glaucoma is an increased pressure within the eye that left untreated, can cause blindness. These complications occur in less than half of those with port-wine stains of the forehead and eyelids. All infants with a port-wine stain in those areas should have a thorough eye examination, and if indicated, further brain imaging.

Occasionally, there may be very gradual enlargement of tissues surrounding a port-wine stain, especially if it is affecting an arm or leg. All children with large port-wine stains should be followed for any growth problems.

With time, port-wine stains can develop small blood vessel growths called vascular blebs. These can bleed easily and may be removed.

Treatment of Port-Wine Stains

The use of cover-up makeup has been a common treatment for port-wine stains. Your doctor can provide you with more information about products that are made to cover up birthmarks .

Various methods have been tried in the past to remove port-wine stains, but none have worked well. New types of vascular lasers show the best results with the least amount of risk and side effects. Laser treatment of port-wine stains is FDA-approved and available at many dermatologists' offices around the country. Laser surgery is performed on an outpatient basis. Several treatments are usually required, given at two month intervals. In a small number of patients, lasers can totally clear up the port-wine stain. They lighten the vascular mark 50-90 percent. For reasons that are not fully understood, a small number of patients will not respond well to laser therapy.

There are several risks of laser therapy. An increase or decrease in skin color can occur, leaving patchy tanning 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, as there is no cutting of the skin. General anesthesia is not required for most adults but topical anesthesia (applying a cream) is available. However, general anesthesia is often necessary for toddlers and young children. If putting the child to sleep is required, there are some risks to general anesthesia as well as higher costs.

Most vascular birthmarks go away 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 about vascular birthmarks, call toll free (888) 462-DERM (3376) to find a dermatologist in your area.

AAD Web site: www.aad.org
Toll-free: (888) 462-DERM (3376)
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