Birthmarks

What are birthmarks?

Birthmarks are colored marks on the skin that are present at birth or develop shortly after birth. They can be many different sizes, shapes, and colors, including brown, tan, black, blue, pink, white, red, or purple. Some birthmarks appear on the surface of the skin; some are raised above the surface of the skin; and some are located under the skin.

What causes birthmarks?

It is not clear why some children have birthmarks and others do not. Some birthmarks appear because a child has extra color (pigment) in his or her skin. Other birthmarks appear because a child's blood vessels did not develop normally or are grouped together too closely. Many folktales and myths exist about the causes of birthmarks, but none has been proven to explain the true causes of birthmarks.

What kinds of birthmarks are there?

• Salmon patches (also called stork bites, angel kisses, and macular stains). Salmon patches are thin, flat, light pink or red birthmarks. They occur most frequently on the back of the neck, the upper eyelids, upper lip, or between the eyebrows.
• Congenital moles (nevi). Congenital moles can appear anywhere on the body. They vary in size and shape, and are generally brown in color.
• Café-au-lait spots. Café-au-lait spots are smooth, generally oval birthmarks. They range in color from light brown to chocolate brown and are usually found on the torso, buttocks, and legs.
• Mongolian spots. Mongolian spots are smooth, brown or blue-gray birthmarks. They usually are irregular in shape and are commonly found across the lower back and buttocks.
• Hemangiomas. Hemangiomas are raised, blue, red, or purple birthmarks formed by a clump of immature blood vessels. They can be many sizes and shapes and are found both on the surface of the skin and deeper in the body.
• Port-wine stains. Port-wine stains are birthmarks that are pink-red at birth and then become a darker red-purple color. Port-wine stains are formed by blood vessels that did not develop properly. They can be small or they can cover a large area of the body.

Do birthmarks need to be treated?

Most birthmarks are harmless and need no treatment. They often fade or disappear as a child grows older.

A birthmark that causes problems with sight, breathing, hearing, speech or movement may need treatment. Birthmarks that are found on internal organs always need treatment and may be associated with more serious problems. Treatment is most common for hemangiomas and port-wine stains and can include corticosteroids, laser therapy, and surgery.

Sometimes the appearance of a large birthmark can make a child or the parents of a child feel shy or self-conscious. In some cases, makeup or hairstyles can hide birthmarks. Counseling and/or support groups may also help with any emotional issues caused by a birthmark.

Is it important to have birthmarks checked?

More than 90% of birthmarks are diagnosed by a careful medical history and physical exam.¹ Some birthmarks stay the same as a child grows older, while some birthmarks fade or disappear. Others grow quickly over a short period of time. Although most are harmless, all birthmarks or any changes in a birthmark need to be checked by a health professional.

Frequently Asked Questions

There are no symptoms of birthmarks. They simply are colored marks on the skin. One kind of birthmark can look very different from another kind of birthmark. Birthmarks can:

• Be flat or raised.
• Have regular or irregular borders.
• Be many different colors, including brown, tan, black, pale blue, pink, red, or purple.
• Be smooth or lumpy.
• Be thin lines of color or solid color.
• Be only on the surface of the skin or extend into the tissues under the skin.
• Grow quickly, remain the same size, shrink, or disappear over time.

All birthmarks need to be checked by a health professional. Most do not need treatment. Certain changes in a birthmark or certain types of birthmarks may need to be watched closely and/or treated. See a health professional if a birthmark:

• Bleeds.
• Develops an open sore (ulcer).
• Becomes infected.
• Interferes with normal functioning or vision.
• Grows suddenly or becomes painful.

More than 90% of birthmarks are diagnosed by a careful medical history and physical exam.¹ Sometimes a health professional will monitor changes in a birthmark by taking photos of the birthmark over a period of time. All birthmarks need to be checked by a health professional.

If a health professional suspects that your child has other problems, he or she may do a blood test or do other tests to check your child's internal organs (liver, lungs, stomach, or intestines). Additional tests might include MRI or ultrasound. On rare occasions, a health professional cuts out a piece of the birthmark (biopsy) to make sure the birthmark is not cancerous.

Many birthmarks fade or disappear over time and require no treatment. Some birthmarks do not fade but still do not need treatment.

When a child's birthmark does not need treatment, often a health professional can tell a parent what to expect—whether it will grow, shrink, or fade—and can help parents with any issues relating to the birthmark. Many parents need to be reminded that their child's birthmark is normal, painless, and likely to fade or disappear. If you or your child feel shy or self-conscious about a birthmark, ask your health professional about makeup and hairstyles to hide the birthmark and/or support groups and counseling.

Treatment for birthmarks can be controversial. It is important to understand the benefits and risks of treatment and to understand that not all birthmarks can be treated. Ask your doctor to show you photographs of birthmarks that have been treated and photographs of birthmarks that have not been treated.

Of all the types of birthmarks, hemangiomas are the most likely to be treated. Although hemangiomas can look painful or ugly, most shrink without treatment. Only about 25% of hemangiomas need treatment.¹ The type of treatment given depends on the age of the child, as well as the type, size, rate of growth, and location of the hemangioma. For example, a fast-growing hemangioma near a child's eye needs treatment, as do those that may leave significant scars. Hemangiomas on internal organs always need treatment.

Treatment for birthmarks includes:

• Corticosteroids, such as prednisone. Corticosteroids can be taken as pills or injected directly into a hemangioma to shrink it or to stop it from growing. Side effects of corticosteroids (such as weight gain or round face) usually disappear after treatment stops. Most birthmarks treated with corticosteroids shrink within 2 to 4 weeks.
• Interferon alfa-12. In very rare cases, corticosteroids do not shrink or stop a hemangioma from growing. Interferon alfa-12 may then be used to reduce the size of the hemangioma. This treatment usually lasts 3 to 6 months and has serious side effects including fever, irritability, neutropenia, and liver problems.
• Laser therapy. Lasers are often used on birthmarks that are close to the surface of the skin, such as port-wine stains. Sometimes, laser therapy can stop a hemangioma from growing, but it may not work to treat a deeper hemangioma.
• Surgery. A hemangioma needs to be surgically removed when other treatments have not worked or when the hemangioma is on an internal organ. Surgical removal of a hemangioma may leave a scar, which may be removed or faded with other treatments.

After your child's birthmark has been treated with surgery or laser therapy, keep your child's fingernails trimmed short to keep him or her from scratching the treated area. It also is important to keep your child out of the sun for several weeks after surgery. When out in the sun, use sunscreen on your child's treated areas until they are completely healed.

Birthmarks are best treated by plastic surgeons or dermatologists.

Even though most birthmarks do not cause physical harm, they may make you or your child feel shy or self-conscious. Each person is different and reacts differently to a birthmark; what bothers one person may not bother another. Parents of a child with a birthmark can reduce the impact that it has on their child's life by understanding and accepting that the birthmark is normal.

If you or your child is bothered by a birthmark, talk with your health professional about treatment options, makeup or hairstyles than can hide a birthmark, and/or support groups and counseling.

If your child has a raised birthmark, the following may be helpful:

• Avoid scraping or scratching it. Hemangiomas contain blood vessels that may bleed.
• If a hemangioma becomes sore and bleeds (ulcerates), apply pressure to the area continuously with a clean pad for 10 minutes and contact your health professional for more advice.
• Apply an antibiotic ointment to small injuries to a birthmark. If the injury is large, contact a health professional.
• Once a hemangioma starts to shrink, the skin may become soft and easily damaged by the sun or by rough treatment. Ask your health professional how to care for it.

After your child's birthmark has been treated with surgery or laser therapy, keep your child's fingernails trimmed short to prevent him or her from scratching the treated area. It also is important to keep your child out of the sun for several weeks after surgery. When out in the sun, use sunscreen on your child's treated areas until they are completely healed.

Organizations

Citations

1. Grevelink SV, Mulliken JB (2003). Vascular anomalies. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 6th ed., pp. 1002–1019. New York: McGraw-Hill.

Other Works Consulted

• Abel EA (2002). Benign cutaneous tumors. In DC Dale, DD Federman, eds., Scientific American Medicine, section 2, part 11. New York: WebMD.

• Chang MW, Orlow SJ (2003). Birthmarks section of Neonatal, pediatric, and adolescent dermatology. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 6th ed., p. 1369. New York: McGraw-Hill.

Author:	Colleen Cronin	Last Updated May 5, 2005
Medical Review:	Michael J. Sexton, MD - Pediatrics Alexander H. Murray, MD, FRCPC - Dermatology
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