What Are Birthmarks?
Birthmarks are skin marks that can appear on a baby before or shortly after birth. They can be either flat or raised, have smooth or uneven edges, and come in various colors, including brown, tan, black, pale blue, pink, red, or purple.
Most birthmarks are harmless and may even fade or shrink over time. However, some birthmarks can be linked to other health issues.
What Causes Birthmarks?
The exact cause of most birthmarks is unknown. They cannot be prevented, nor are they a result of any actions taken or not taken during pregnancy. Most birthmarks are not caused by skin trauma during childbirth. While some types may be hereditary, a specific genetic cause has not been identified.
What Are the Types of Birthmarks?
There are two main types of birthmarks, each with different causes:
- Vascular birthmarks occur when blood vessels do not form correctly. This can result in an excess number of blood vessels or vessels that are wider than usual.
- Pigmented birthmarks are caused by an overgrowth of the cells responsible for producing pigment (color) in the skin.
Vascular Birthmarks
The most common types of vascular (blood vessel) birthmarks are macular stains, hemangiomas, and port-wine stains:
Macular stains: Also known as salmon patches, angel kisses, or stork bites, these faint red marks are the most prevalent type of vascular birthmark. Macular (MA-kyuh-ler) stains usually appear on the forehead, eyelids, back of the neck, nose, upper lip, or back of the head. They may become more noticeable when the baby cries. Typically, these marks fade on their own by the time a child is 1 to 2 years old, although some may persist into adulthood.
Hemangiomas: Hemangiomas can be superficial (on the skin surface, known as «strawberry marks»), deep (below the skin surface), or compound (affecting both layers). A hemangioma (hee-man-jee-OH-muh) can be slightly raised and bright red, usually becoming visible a few days or weeks after birth. Deep hemangiomas might appear bluish due to blood vessels in deeper skin layers. These birthmarks grow rapidly during the first six months of life and typically shrink and disappear by age 5 to 10. Larger hemangiomas may leave abnormal skin, which can be corrected with surgery. Some may leave red pigmented skin, which can be treated with special laser therapy. Although hemangiomas can occur anywhere on the body, they are most common on the head or neck and can cause issues if they interfere with sight, feeding, breathing, or other functions.
Port-wine stains: These discolorations resemble spilled wine and usually appear on the face, neck, arms, or legs. Port-wine stains can vary in size, growing only as the child grows. They tend to darken over time and may thicken and become pebbly in middle adulthood if untreated. Unlike other birthmarks, port-wine stains do not fade on their own. Doctors monitor stains near the eye to ensure they do not cause problems. If port-wine stains involve certain facial areas, additional tests such as an MRI may be necessary.
Pigmented Birthmarks
The most common types of pigmented birthmarks are café-au-lait spots, Mongolian spots, and moles:
Café-au-lait spots: These spots are named for their color, resembling coffee with milk. They can appear anywhere on the body and may increase in number as a child grows older. A single spot is usually not a concern, but if your child has six or more spots larger than a pencil eraser (in younger children) or larger than a dime (in older children), consult your doctor. Multiple café-au-lait spots can indicate neurofibromatosis, a genetic disorder that causes abnormal cell growth in nerve tissues.
Mongolian spots: These flat, bluish-gray patches are often found on the lower back or buttocks. They are most common in children with darker skin, such as those of Asian, American Indian, African, Hispanic, and Southern European descent. Mongolian spots usually fade, often completely, by school age without requiring treatment.
Moles (congenital nevi, hairy nevus): Moles, or nevi (NEE-vye), are brown spots that most people develop at some point in their lives. A mole present at birth is called a congenital nevus (NEE-viss) and will last a lifetime. Although the risk is low, large or giant congenital nevi have a higher likelihood of developing into skin cancer (melanoma) later in life. Smaller congenital nevi may have a slightly increased risk. Moles can be tan, brown, or black; flat or raised; and may have hair growing from them.
How Are Birthmarks Treated?
Macular stains usually fade away on their own, although those on the back of the neck may last longer but are typically not very noticeable.
Vascular birthmarks, such as port-wine stains and certain hemangiomas, can be treated:
- Port-wine stains and some hemangiomas can be disfiguring and distressing for children. Small hemangiomas in less visible areas often do not require treatment as they typically shrink by the time a child is 10 years old. For larger or more visible hemangiomas, doctors may use medication applied directly to the hemangioma, given intravenously (through an IV), or taken orally.
- Laser treatment(using highly concentrated light energy) can lighten port-wine stains. Most stains become lighter after several treatments with a «pulsed-dye» laser, although some may return and need re-treatment. Laser treatment often begins in infancy when the stain and blood vessels are smaller. Stains on the head and neck respond well to this treatment. Additionally, special makeup can be used to conceal a port-wine stain.
Pigmented birthmarks are usually left alone, except for congenital moles and, occasionally, café-au-lait spots:
- Congenital moles: Doctors can remove these, particularly large or giant congenital nevi, with surgery, although larger ones may be more difficult to remove.
- Café-au-lait spots: Laser treatment can remove these spots, but they often return.
When Should I Call the Doctor?
A doctor should examine a birthmark when it first appears to determine its type and decide on any necessary monitoring or treatment.
Contact the doctor if a birthmark starts to bleed, hurt, itch, or becomes infected. For any bleeding, clean the wound with soap and water and apply firm pressure using a gauze bandage until the bleeding stops. If the bleeding doesn’t stop, call the doctor.
Hemangiomas can sometimes develop open sores that may become infected. Although pigmented birthmarks rarely cause problems, moles should be monitored throughout life for changes in size, color, or texture.
What Else Should I Know?
It can be surprising to see a birthmark on your newborn. If the birthmark is clearly visible, people might ask questions or stare, which can feel rude. Having a simple explanation ready can help manage these situations. Most people mean no harm, but it’s okay to let them know if they’ve crossed a line.
Children observe how their parents handle such situations, which influences how they cope with others’ reactions. Talking openly and simply about a birthmark helps children accept it as a natural part of themselves, much like hair color. Practice simple responses they can use if asked about it, such as «It’s just a birthmark. I was born with it.» Being around supportive family and friends who treat them normally also helps children emotionally.