Vascular Birthmarks

Newborns often have temporary pimples or blotches that soon disappear as they adapt to life outside the womb. It's also quite common to see birthmarks on their skin at birth or shortly after. Birthmarks range from hardly noticeable to disfiguring, but no matter how large or small they are, they can be upsetting.

Birthmarks can be flat or raised, have regular or irregular borders, and have different shades of coloring from brown, tan, black, or pale blue to pink, red, or purple. The two main types of birthmarks are red, vascular birthmarks (for example, "strawberry" hemangiomas, port-wine stains, and "stork bites") and pigmented birthmarks (such as moles and Mongolian spots).

They're mostly harmless and many even go away on their own or shrink over time. Sometimes birthmarks are associated with other health problems, though, so talk to your doctor about whether this might be the case for your child.

What causes birthmarks

Birthmarks can't be prevented and they're not caused by anything done or not done during pregnancy. There's no truth to old wives' tales about "stains" being caused by something the mother did or ate. The cause of most birthmarks is unknown. They can be inherited, but usually are not, and typically are unrelated to trauma to the skin during childbirth.

Types of birthmarks

The two main types of birthmarks are differentiated by their causes. Vascular (blood vessel) birthmarks happen when blood vessels don't form correctly—either there are too many of them or they're wider than usual. Pigmented birthmarks are caused by an overgrowth of the cells that create pigment in skin.

  • Vascular birthmarks: The most common vascular birthmarks are macular stains, hemangiomas, and port-wine stains:

    • Macular stains. Also called salmon patches, angel kisses, or stork bites, these faint red marks are the most common type of vascular birthmark. They're often on the forehead or eyelids, the back of the neck, or on the nose, upper lip, or on the back of the head. They may be more noticeable when the baby cries. Most often they fade on their own by the time a child is 1 to 2 years old, although some last into adulthood.
    • Hemangiomas. Hemangiomas are classified as superficial when they appear on the surface of the skin ("strawberry marks") and deep when found deeper below the skin's surface. They can be slightly raised and bright red and sometimes aren't visible until a few days or weeks after a baby is born. Deep hemangiomas may be bluish because they involve blood vessels in deeper layers of the skin. Hemangiomas grow rapidly during the first 6 months or so of life, but usually shrink back and disappear by the time a child is 5 to 9 years old. Some, particularly larger ones, may leave a scar as they regress that can be corrected by minor plastic surgery. Most are on the head or neck, although they can be anywhere on the body, and can cause complications if their location interferes with sight, feeding, breathing, or other body functions.
    • Port-wine stains. These are discolorations that look like wine was spilled on an area of the body, most often on the face, neck, arms, or legs. Port-wine stains can be any size, but grow only as the child grows. They tend to darken over time and can thicken and feel like pebbles in midlife adulthood unless treated. They never go away on their own. Ones near the eye must be assessed for possible complications involving the eye.
  • Moles (congenital nevi, hairy nevus). Mole is a general term for brown nevi (one is called a "nevus"). Most people get moles at some point in life. One present at birth is called a congenital nevus and will last a lifetime. Large or giant congenital nevi are more likely to develop into skin cancer (melanoma) later in life. Smaller moles may have a slight increase in risk. Moles can be tan, brown, or black; flat or raised; and may have hair growing out of them.

What should I do if my child has a birthmark?

If a hemangioma or birthmark is very large or affects the breathing system (airway or lungs) or another large organ system, it could be life-threatening. If a hemangioma has uncontrollable bleeding, this could also be life-threatening. Large and/or life-threatening lesions should be evaluated by a multidisciplinary team of specialists that includes plastic surgeons, dermatologists, ophthalmologists, radiologists, and other specialists, depending on what organs are involved.

Treating birthmarks

Pigmented birthmarks are usually left alone, with the exception of moles and, occasionally, café-au-lait spots. Moles—particularly large or giant congenital nevi—sometimes are surgically removed, though larger ones may be more difficult to remove.

Vascular birthmarks, on the other hand, can be treated. The exception is macular stains, which usually fade away on their own; ones at the back of the neck may be more persistent but are not very noticeable.

Port-wine stains and certain hemangiomas can be disfiguring and embarrassing for children. Hemangiomas are usually left alone, as they typically shrink back into themselves by age 9. Larger or more serious hemangiomas often are treated with steroids.

Lasers are the treatment of choice for port-wine stains. Most lighten significantly after several treatments with a "pulsed-dye" laser, although some return and need re-treatment. Laser treatment is often started in infancy when the stain and the blood vessels are smaller. Marks on the head and neck are the most responsive to laser treatment. Special opaque makeup also can camouflage a port-wine stain.

Helping kids deal with birthmarks

It can be a shock at first to see a birthmark on your newborn. Nobody is perfect, yet many people have an image of a perfect baby in their heads. If the birthmark is clearly visible, people might ask questions or stare, which can feel rude. It helps to have a simple explanation ready to handle intrusions like this. Most people mean no harm, but it's also OK to let them know if they've gone too far.

Even at a young age, kids watch how their parents respond to situations like this. This is how they lean how to cope with others' reactions. Talking simply and openly about a birthmark with kids makes them more likely to accept one as just another part of themselves, like hair color. And practice simple answers they can use when asked about it: "It's just a birthmark. I was born with it." It's also important emotionally for kids to be around supportive family and friends who treat them normally.

What is a vascular malformation?

A vascular malformation is another type of birthmark, or congenital (present at birth) growth, made up of arteries, veins, capillaries, or lymphatic vessels. There are several different types of malformations and they are named according to which type of blood vessel is predominantly affected. A vascular malformation is also known as lymphangioma, arteriovenous malformations, and vascular gigantism.

What is the difference between a hemangioma and a vascular malformation?

Most hemangiomas are not usually present at birth or are very faint red marks. Shortly after birth, however, they grow rapidly - often faster than the child's growth. Over time, they become smaller (involute) and lighter in color. The process of involution may take several years.

Vascular malformations are present at birth and enlarge proportionately with the growth of the child. They do not involute spontaneously and may become more apparent as the child grows.

What causes hemangiomas and vascular malformations?

The cause for hemangiomas and vascular malformations is usually sporadic (occurs by chance). However, they can also be inherited in a family as an autosomal dominant trait. Autosomal dominant means that one gene is necessary to express the condition, and the gene is passed from parent to child with a 50/50 risk for each pregnancy. Males and females are equally affected and there is great variability in expression of the gene. In other words, a parent may unknowingly have had a hemangioma because it faded, but the child is more severely affected. The family may not come to the attention of a geneticist until the birth of the child with a more severe condition. Other relatives with mild expression of the gene are often discovered at that time, confirming autosomal dominant inheritance.

Hemangiomas and vascular malformations are a manifestation of many different genetic syndromes that have a variety of inheritance patterns and chances for reoccurrence, depending on the specific syndrome present.

Hemangiomas are present in up to 12 percent of babies in the first year of life. Overall, females are more often affected than males.

What should I do if my child has a hemangioma or vascular malformation?

If a hemangioma or vascular malformation is very large or affects the breathing system (airway or lungs) or another large organ system, it could be life-threatening. If a hemangioma has uncontrollable bleeding, this could also be life-threatening. Large and/or life-threatening lesions should be evaluated by a multidisciplinary team of specialists that includes plastic surgeons, dermatologists, ophthalmologists, radiologists, and other specialists, depending on what organs are involved.

Treatment for hemangiomas:

Treatment for hemangiomas depends upon their size, location, and severity. Treatment is usually not recommended for small, non-invasive hemangiomas, since they will become smaller (involute) on their own. However, hemangiomas that cause bleeding problems, feeding or breathing difficulties, growth disturbances, or impairment of vision may require medical or surgical intervention.

Treatment may include the following:

  • steroid medications
  • embolization of the blood vessels (injection of material into the blood vessels to block the blood inflow)
  • laser or surgical removal

Treatment for vascular malformations:

Treatment for vascular malformations depends upon the type of the malformation. Each type of malformation is treated differently. Laser therapy is usually effective for capillary malformations or port wine stains, which tend to be flat, violet or red patches on the face. Arterial malformations are often treated by embolization (blood flow into malformation is blocked by injecting material near the lesion). Venous malformations are usually treated by direct injection of a sclerosing (clotting) medication which causes clotting of the channels. Most often, a combination of these various treatments is used for effective management of the lesion.

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