Birthmarks

  • Overview

    Birthmarks: Overview

      birthmarks-salmon-patch.jpg
    Salmon patches: This harmless birthmark will fade with time and tends to be most noticeable when your baby cries or becomes too warm.

    What exactly is a birthmark?

    If your baby has a birthmark, you’ll likely see a spot, patch, or lump that looks different from the rest of your baby’s skin. You may see this when your baby is born. Some birthmarks appear shortly after birth.

    Birthmarks come in many shapes and colors. You may see a flat or raised mark. It may the size of a pinhead or cover a large area of your child’s skin. Most birthmarks fall somewhere in between. A birthmark can be pink, red, tan, brown, or any other color. Some look like a bruise. Others look like a stain on the skin.

    Some birthmarks are common. It’s estimated that between 3% and 10% of babies are born with a type of birthmark called a (he-man-gee-oh-ma). Other birthmarks, such a port-wine stain, are less common.

    Certain types of birthmarks, such as a salmon patch or hemangioma, often fade on their own. Others, such a mole, tend to remain on the skin for life.

    Yes, a mole is a birthmark when a baby is born with it — or it appears on the skin shortly after birth.

    Pictures of different birthmarks

    Why a dermatologist should examine your baby’s birthmark

    One thing that most birthmarks have in common is that they’re harmless. Yet, if you see a birthmark on your child’s skin, it’s wise to have a dermatologist examine it.

    What you think is a birthmark could be the first sign of a skin disease.

    It’s also possible that your baby has a harmless birthmark that will grow quickly. Seeing a birthmark grow quickly can be scary. Knowing this will happen and learning what to watch for can help put your mind at ease.

    Some birthmarks are a sign that something is going on inside your baby’s body.

    By making an appointment with a dermatologist as soon as you notice the birthmark, you’ll know what to expect. A dermatologist can also tell you whether treatment is recommended — be it a birthmark or skin condition.

    Find a dermatologist

    Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.


    References
    American Academy of Dermatology, “Red, white and brown: Defining characteristics of common birthmarks will determine type and timing of treatment.” News release issued Feb 4, 2011.

    Anderson KR, Schoch JJ. “Increasing incidence of infantile hemangiomas (IH) over the past 35 years: Correlation with decreasing gestational age at birth and birth weight.” J Am Acad Dermatol. 2016 Jan;74(1):120-6.

    Del Pozzo-Magana B, Dizon M, et al. “Newborn skin disease, Part 1: Birthmarks.” In: Society for Pediatric Dermatology and the American Academy of Dermatology’s Basic Dermatology Curriculum. Peer review by: Maguiness S. May 2016.


    Birthmarks

  • Symptoms

    Birthmarks: Signs and symptoms

    Pictures of different birthmarks

    If you’ve already read “What exactly is a birthmark?,” you already know birthmarks come in many shapes and sizes. Here you’ll see what the different types of birthmarks can look like.

      birthmarks-strawberry-hemangioma.jpg
    Strawberry hemangioma on baby's body
    Strawberry hemangioma
    (he-man-gee-oh-ma)

    Medical name: Superficial infantile hemangioma

    What it looks like:
    The birthmark usually looks like a strawberry-colored lump that feels firm and rubbery. Sometimes, instead of a seeing a lump, you may find a strawberry-colored patch or patches on your child’s skin.

    Whether a lump or patch, this birthmark tends to grow quickly, usually until the child is 4 to 6 months old. Some grow for a longer time. When a strawberry hemangioma stops growing, it may stay the same or start to shrink.

    In time, all strawberry hemangiomas shrink. As it shrinks, the color changes to slate gray. The birthmark also begins to soften.

    When the birthmark shrinks, the skin may break down, causing pain. If this happens, see your child’s dermatologist.  The right wound care can help speed healing and eliminate the pain.

    Where it usually develops on the body: Most occur on the head or neck, but this birthmark can develop anywhere on the skin or moist tissue inside the mouth or anus.

    Will it go away? Yes, it usually goes away on its own, leaving little evidence that it was ever there. About 10% disappear by the age 1 and, 90% are gone by the time a child is 10 years old.

      birthmarks-deep-hemangioma.jpg
    Deep hemangioma on baby's chest
    Deep hemangioma

    Medical name: Cavernous infantile hemangioma

    What it looks like: This birthmark looks like a lump that sits deep in the skin. It may be skin colored or have a bluish-purple color as shown here. You may see thin red lines, which are visible blood vessels. When you touch this birthmark, it often feels warm and firm.

    This birthmark can grow quickly and grow for up to a year. Sometimes, the growth stops suddenly. Other times, it slows.

    While it's growing, a deep hemangioma can be painful. Some break open and bleed.

    If this happens, make an appointment for your child to see a board-certified dermatologist.

    Where it usually develops on the body: Anywhere on the skin.

    Will it go away? Most fade on their own, but it takes time. About half disappear by 5 years of age. Nearly 90% will be gone by the time a child is 10 years old. As it fades, it can leave a light spot or scar on the skin.

      birthmarks-salmon-patch.jpg
    Angel's kiss on baby's face
    Salmon patch

    Medical name: Nevus simplex

    What it looks like: You’ll see a flat, pink, red, or salmon-colored spot or patch.

    If you gently press on this birthmark, the color tends to fade. The color becomes more noticeable when your baby cries, becomes overheated, or feels irritated.

    Some babies have a few spots or patches, as shown here. When a salmon patch appears on the face, it’s often referred to as an angel’s kiss. On the back of the neck, people often call this birthmark a stork’s bite.

    Where it usually develops on the body: Usually the face or the back of the neck, but it can appear elsewhere on the skin.

    Will it go away? On the face, this birthmark tends to disappear between 1 and 3 years of age. When it appears on the back of the neck (stork’s bite) or elsewhere, it may fade but not disappear.

      birthmarks-cafe-au-lait.jpg
    Café-au-lait spot on child's face
    Café-au-lait (café-oh-lay) spot

    Medical name: Café-au-lait macule

    What it looks like: This flat spot is darker than the rest of your child’s skin. It has an easy-to-see border and is the same color throughout. The color ranges from that of coffee with milk on fair skin (shown here) to the color of black coffee on dark skin. The size varies greatly. It can be the size of a freckle or cover a large area of skin.

    Most children have one spot, but some kids have more.

    If your child has 6 or more café-au-lait spots or you see spots that look like freckles developing around a café-au-lait spot, it’s time to see a dermatologist.

    Where it usually appears on the body: Buttocks, but it can appear anywhere on the skin, including the face (shown here).

    Will it go away? No. This spot remains on the skin for life.

    If your child has a café-au-lait spot in a visible place, a dermatologist can tell you whether treatment can help.

      birthmarks-congenital-mole.jpg
    Mole on child's skin
    Mole

    Medical name: Congenital melanocytic nevus

    What it looks like: A mole can appear on the skin as a small spot or cover a large area of skin. The mole may feel smooth, warty, or like cobblestones.

    Moles come in many colors, but most are brown or tan.

    Where it usually appears on the body: Like moles that appear later in life, this mole can appear anywhere on the skin.

    Will it go away? A few disappear, but most remain on the skin for life. Because melanoma, the most-serious skin cancer, can develop in a mole, this birthmark should be checked by a dermatologist.

      birthmarks-mongolian-spot.jpg
    Mongolian spot on buttocks
    Mongolian spot

    Medical name: Dermal melanocytosis

    What it looks like: Often looking like a bruise, this birthmark may be light blue, dark blue, or blue gray.

    A baby may have one spot or several. Each spot can vary greatly in size.

    This birthmark occurs in all races. It’s least common in people who have white skin and most common in Asians.

    Where it usually appears on the body: Most appear on the lower back or buttocks, but it can show up anywhere on the skin.

    Will it go away? These often go away by the time a child is 3 to 5 years old. A few people still have this birthmark as adults.

    birthmarks-port-wine-stain.jpg
    Port-wine stain on a child's arm and upper chest

    Port-wine stain

    Medical name: Nevus flammeus

    What it looks like: At birth, you’ll see a spot(s) or patch(es) that can be pink, red, or purple.

    As the child grows, so will this birthmark. In time, the birthmark tends to thicken and darken. As it thickens, the texture can change. Ridges may develop. Sometimes, the birthmark feels like cobblestones on the skin.

    Where it usually develops on the body: A port-wine stain usually develops on the face; however, it can appear anywhere on the skin.

    Will it go away? Without treatment, this birthmark remains on the skin for life. Mikhail Gorbachev, the former president of the Soviet Union, has a port-wine stain.

    birthmarks-nevus-sebaceous.jpg
    Nevus sebaceous on child's scalp
    Nevus sebaceous
    (knee-vus seh-bay-ceous)

    Medical name: Organoid hamartoma

    What it looks like: What you see varies with the child’s age.

    When it develops on the scalp of a newborn, this birthmark often looks like a slightly raised, hairless (or nearly hairless) patch. Your baby’s hair will grow around it, as shown in the picture above.

    As your child grows, this birthmark may stay the same or change. It’s most likely to change during the teen years. It may thicken. You may notice the birthmark changes color, becoming slightly yellow or orange. The surface can feel pebbly or warty.

    Where it usually develops on the body: This birthmark usually appears on the scalp or face. Occasionally, it develops on the neck or another area of the body.

    Will it go away? This birthmark can change, but it doesn’t go away.

    birthmarks-white-spot.jpg
    White spot birthmark
    White spot

    Medical name: Hypopigmented macule

    What it looks like: Many people call this a white spot, but this birthmark is often an area of skin that has less color than the baby’s surrounding skin. This spot can be raised or flat. It may be round, oval, or another shape. Some are leaf shaped.

    Where it usually appears: Most develop on the chest, abdomen, back, or buttocks. They can also appear anywhere else on the skin.

    Will it go away? Most disappear.


    Images:
    1,4 Used with permission of the Journal of the American Academy of Dermatology.

    • J Am Acad Dermatol. 2008;58:S16-22.
    • J Am Acad Dermatol. 1999;40:877-90.

    2,3,5,6,7,8,9 Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

    References
    American Academy of Dermatology, “Red, white and brown: Defining characteristics of common birthmarks will determine type and timing of treatment.” News release issued Feb 4, 2011.

    Barnhill RG and Rabinovitz H. “Benign melanocytic neoplasms.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1713,1720-3.

    Enjolras O. “Vascular malformations.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1582-5.

    Garzon MC “Infantile hemangiomas.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1567-8.

    McCalmont TH. “Adnexal neoplasms.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1695-6.


    Birthmarks


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  • Causes

    Birthmarks: Who gets and causes?

    birthmarks-hemangioma-sisters.jpg
    Sisters with salmon patches: Sometimes, a birthmark runs in a family like this salmon patch, which has nearly faded on the older sister.

    Who gets birthmarks?

    Birthmarks are common. Research shows that about 10% of babies are born with a type of birthmark known as a hemangioma (he-man-gio-ma).

    Fortunately, most hemangiomas go away on their own by the time a child is 10 years old. Many disappear sooner.

    Babies may be more likely to have a hemangioma if they are:

    • Premature
    • Less than 5-1/2 pounds at birth
    • Female
    • White
    • Born with a sibling (twin, triplet, etc.)

    Birthmarks that cause a brown mark on the skin, such as moles and café-au-lait (café-oh-lay) spots, are also common. About 1 in 100 babies has a small mole. Larger moles are less common. Babies of all races can have a mole.

    A Mongolian spot is another common birthmark. Asians are most likely to be born with one of these spots. Mongolian spots are less common in other races.

    While some babies have a greater risk of developing certain birthmarks, there’s no way to know whether a baby will have a birthmark.

    What causes a birthmark?

    Different types of birthmarks have different causes. Before explaining these causes, it’s important to put some superstitions to rest.

    Birthmarks don’t form because a pregnant woman ignores a food craving, touches her belly while worried, or eats certain foods. These are myths.

    We still don’t know exactly why birthmarks develop, but here’s what scientists have learned so far.

    The cause varies with the type of birthmark. Some birthmarks form when blood vessels do not form properly. This can cause your baby to have one of the following birthmarks:

    • Strawberry hemangioma
    • Deep hemangioma
    • Port-wine stain
    • Salmon patch

    Other birthmarks appear when cells that give our skin color, melanocytes (meh-lan-oh-cites), clump together. That’s why newborns develop moles or café-au-lait spots.

    A nevus sebaceous (knee-vus seh-bay-ceous) develops when parts of the skin overgrow.

    You cannot prevent these things from happening by satisfying every food craving or keeping your hands off your belly while worried. So, it’s okay to ignore that desire for a turkey sandwich at 2:00 a.m.


    References
    Barnhill RG and Rabinovitz H. “Benign melanocytic neoplasms.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1713,1720-3.

    Enjolras O. “Vascular malformations.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1582-5.

    Garzon MC “Infantile hemangiomas.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1567-8.

    Leffell DJ. Total skin: The definitive guide to whole skin care for life.” Hyperion, United States of America, 2000:286.

    Nouri K, Patel AR, et al. “Mohs micrographic surgery.” In: Nouri K. Skin Cancer. The McGraw-Hill Companies, Inc., China, 2008:482-490.

    McCalmont TH. “Adnexal neoplasms.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1695-6.


    Birthmarks

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  • Treatment

    Birthmarks: Diagnosis, treatment, and outcome

    birthmarks-examining-babys-skin.jpg
    Have a dermatologist examine a birthmark as soon as you notice it, so you know what type of birthmark your child has and whether it needs treatment.

    How do dermatologists diagnose a birthmark?

    Often, a dermatologist can tell you what type of birthmark your child has by examining it.

    To examine a birthmark, your dermatologist may use an instrument called a Wood’s lamp. This device lets a dermatologist see parts of the skin that cannot be seen with the naked eye. This won’t hurt. It’s just a special light.

    If your child has many birthmarks, your dermatologist may recommend some testing.

    Having a lot of birthmarks can be a sign of something going on inside your child’s body. For example, if a child has many café-au-lait (cafe-oh-lay) spots, your child could have neurofibromatosis. This is a disease that can cause tumors on the nerves. To rule this out, your child may need an X-ray or CT scan.

    Most of the time, however, a dermatologist only needs to look closely at the birthmark. After the exam, your dermatologist can tell you the:

    • Type of birthmark your child has
    • Precautions, if any, to take
    • Treatment, if any, that’s recommended

    How do dermatologists treat birthmarks?

    While you can leave most birthmarks alone, it’s important to see a dermatologist soon after you notice a birthmark. Some birthmarks can cause a problem later on. Treatment can prevent that.

    Your dermatologist may recommend treatment if your child has a:

    • Strawberry hemangioma (he-man-gee-oh-ma) on the face or groin: This birthmark tends to grow quickly before fading. If one appears near your child’s eye, mouth, or nose, treatment can prevent it from covering that part of your child’s body. In the groin area, treatment can prevent pain later on.

    • Port-wine stain: This birthmark will not go away with time. It can grow and thicken. Early treatment tends to be more effective.

    • Very large or visible birthmark: If the birthmark affects the child’s appearance and could cause problems with self-esteem, your dermatologist may recommend treatment.

    The safest and most effective treatment varies with the birthmark and child. Here’s what your dermatologist may recommend:

    Watch the birthmark: While not a treatment, this offers parents an important option.

    With this approach, parents watch the birthmark carefully. Your dermatologist will tell you what to look for. This allows you to treat the birthmark only if treatment becomes necessary. This can be an effective approach for a strawberry hemangioma, a type of birthmark that can grow quickly.

    Laser therapy: This may be an option for a port-wine stain, a type of birthmark that won’t go away with time.

    Propranolol (pro-pran-oh-lol): This medication can effectively prevent a hemangioma from growing. It can also shrink a growing hemangioma. A special formulation of this drug has proven effective for treating children with large hemangiomas. This drug has been approved to treat this type of birthmark.

    Heart medicine can clear strawberry birthmarks

    Timolol: This medication can also help shrink a growing hemangioma. It comes in liquid form, so you’d apply it to your child’s birthmark. It’s commonly used to treat babies who have glaucoma. When used to treat a hemangioma, dermatologists prescribe a lower dose of the medication than would be used to treat glaucoma.

    Corticosteroid: This medication may be used to shrink a hemangioma. Your child’s dermatologist may prescribe pills or inject the birthmark with this medication.

    Interferon: If your child has a life-threatening birthmark, this may be an option. Your child would need daily shots, so you’d learn how to give these. You’ll also have to watch your child carefully for possible side effects.

    Surgery to remove the birthmark: This type of surgery can be used to cut out a birthmark. It may be recommended if your child has a birthmark that could become a skin cancer, such as a mole.

    When mole removal is recommended, it is often done when the child reaches puberty.

    Surgery can also be helpful for treating a large raised birthmark that won’t go away on its own and affects your child’s appearance.

    Makeup: This may be the right approach for an older child or adult. The right makeup can cover discolored skin. If you have trouble finding makeup that can hide a birthmark, ask your dermatologist for a recommendation.

    What is the outcome for a child’s birthmark?

    Many birthmarks fade on their own. Common birthmarks like hemangiomas tend to fade without treatment. Though hemangiomas can grow a lot bigger before they start to fade.

    Birthmarks that don’t fade with time include café au lait (café-oh-lay) spots, moles, and port-wine stains. They are usually harmless. If one affects a child’s appearance, treatment may be an option.


    References
    American Academy of Dermatology. “Red, white and brown: Defining characteristics of common birthmarks will determine type and timing of treatment.” News release issued Feb 4, 2011.

    Barnhill RG and Rabinovitz H. “Benign melanocytic neoplasms.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1713,1720-3.

    Del Pozzo-Magana B, Dizon M, et al. “Newborn skin disease, Part 1: Birthmarks.” In: Society for Pediatric Dermatology and the American Academy of Dermatology’s Basic Dermatology Curriculum. Peer review by: Maguiness S. May 2016.

    Enjolras O. “Vascular malformations.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1582-5.

    Garzon MC “Infantile hemangiomas.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1567-8.

    Habif TP, Campbell TL, et al. “Hemangiomas of infancy.” In: Dermatology DDxDeck. Mosby Elsevier, China, 2006: Card 140.

    Helwick C. “Timolol gel effective for infantile capillary hemangiomas.” Medscape News. Nov 2012. Last accessed September 2017.

    McCalmont TH. “Adnexal neoplasms.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1695-6.


    Birthmarks

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  • Tips

    Birthmarks: Tips for managing

    birthmarks-baby-strawberry-hemangioma.jpg
    Baby with strawberry hemangioma (he-man-gee-oh-ma): A dermatologist can tell you what type of birthmark your child has and whether it could cause a problem.

    Birthmarks: 3 tips for anxious parents

    Seeing a birthmark on your newborn’s skin can be worrisome. Here’s what dermatologists recommend if your child has a birthmark:

    1. See a dermatologist for a birthmark exam. Most birthmarks are harmless, but having a dermatologist examine it as soon as you notice it is important.

      A dermatologist can tell you what type of birthmark your child has and whether you need to do anything about it.

    2. Understand that most birthmarks are harmless. Most birthmarks pose no risk to the child, so it’s safe to leave them alone.

      If you’re worried that the birthmark’s size or location could have a psychological effect on your child later in life, tell your child’s dermatologist about your concern.

      Dermatologists can often tell you if the birthmark is permanent or will fade with time. Your child’s dermatologist can also tell you about the risks and benefits of treatment. Sometimes, it’s best to wait and watch.

      Other times, early treatment produces the best results. When a child has a port-wine stain — a birthmark that begins as a flat mark that can be red, pink, or purple — early treatment is often recommended.

      A port-wine stain will not go away. Treating it early before it darkens and thickens tends to produce the best results.

    3. Watch for changes. It’s normal for a birthmark to grow as your child grows. Some will grow quickly and then fade without causing a problem.

      When a birthmark grows quickly, it may cause problems. If your child seems to be in pain or the birthmark breaks open, it’s time to call your child’s dermatologist. This birthmark may need wound care.

      If your child’s birthmark is a mole, it’s natural for the mole to grow with the child. Should you see other changes to the mole, such as rapid growth, more than one color or a jagged border, it’s time to call a dermatologist.

    By having a dermatologist examine your child’s birthmark when you first notice it, you’ll know what to expect. You’ll also have an expert to call if the birthmark starts to cause a problem.

    If you need a dermatologist, you can find one at: Find a dermatologist


    References
    American Academy of Dermatology. “Red, white and brown: Defining characteristics of common birthmarks will determine type and timing of treatment.” News release issued Feb 4, 2011.


    Birthmarks

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