Birthmarks

The information in this section has been gathered from existing peer-reviewed and other literature and has been reviewed by expert dermatologists on the CSPA Medical Advisory Board.

Birthmarks are patches of discoloration or abnormal texture on or under a person’s skin. Sometimes these marks appear soon after a baby is born, but most are obvious at birth. In some cases, the birthmarks fade or disappear altogether as the child gets older, but others stay the same or actually get bigger, darker, or thicker. In many cases, birthmarks are both harmless and painless, but facial birthmarks can be a source of stress for people who have them. Some birthmarks, especially those that are larger, may be associated with internal medical conditions that may require evaluation and treatment.

Birthmarks come in a variety of sizes, shapes, and colours. The colour, for example, can range from blue or blue-grey, to brown, tan, black, pink, white, red, or purple. Many birthmarks are soft, raised swellings on the skin; others are smooth. Birthmarks can occur anywhere on the body. The two most common classes of birthmarks are:

1. Red birthmarks, which are usually caused by extra blood vessels clustered together close to the skin surface and are called vascular birthmarks.
2. Pigmented birthmarks, which are due to abnormally increased amounts of melanin in the skin. Melanin is the main pigment that gives skin its colour.

It is not known exactly why some children develop birthmarks and others do not.

Cafe au lait macule Congenital mole Hemangioma Port wine stain

Birthmarks are easily identified by parents and doctors. In some cases, they can indicate an underlying, more serious condition. For this reason, it is a good idea to have your doctor check your child’s birthmarks.

A few birthmarks may resolve on their own by simply fading away. Most, however, will generally be permanent. Surgery or laser treatment may be treatment options, but these should be approached cautiously since scarring may occur. There is a growing body of experience among dermatologists in treating birthmarks, and sophisticated new treatments combining laser therapy with other forms of light seem effective.

Some types of birthmarks may respond to medication. For example, oral beta-blockers or steroids can be taken to reduce the size of infantile hemangiomas.  However, as with any medication, the side effects must be weighed against its benefits.

Some smaller or lighter birthmarks may be effectively covered with cosmetic camouflage cream.

Society emphasizes physical appearance, so having a visible birthmark can really make a person stand out. Children may be particularly sensitive to such treatment. Your and your child’s reactions to how others act when they see the birthmark is important. Here are some ideas for helping you or your child:

• Be positive about people’s reactions. People are often curious and do not know how to react to a visible birthmark. Accept that they are not being rude and try to be polite, friendly or even humorous. It may help to explain the type of birthmark you have. Also, it is okay to be assertive. If other people’s questions seem intrusive, it is all right to let them know.
• Talk to your child about his or her birthmark. Be open, honest, and calm. Use simple terms they can understand. Explain any treatments that they might be getting in the future.
• Show your child how to cope. Children learn by watching other people, especially their parents. Your child will learn how to handle things like hospital visits, making friends, and coping with other people’s reactions by watching you. Therefore, the best way to teach your child is to learn how to respond well to people yourself.

Most birthmarks pose few or no problems, but a person who has a large, obtrusive birthmark on the face may feel very self-conscious. If it’s a child who has the birthmark, parental encouragement and support may be all that’s needed. However, during puberty, the power of parents’ help begins to wane, and the perceptions of others becomes more significant. (For example, unafflicted girls may reject or isolate a peer with a birthmark because they may not want their “blemished” friend to “scare away” boys.) The emotional scars developed during this time may remain with the person for life. As a parent, the best thing to do is to maintain an open dialogue with your child, be as supportive as you can, and consult dermatologists about available treatment options.

For those people with birthmarks who may be limiting their social interactions with others, the support of a psychologist or counsellor may help.

Stork Bite or Angel’s Kisses: These tend to be pink, irregularly shaped, and flat, less than a few inches inches tall and wide, and usually found on the neck, head, or upper lip. Almost half of all newborns have one of these birthmarks. There are no known health problems associated with them, and they usually fade by the end of the first year.

Infantile Hemangioma: These are usually red, raised, and lumpy, and may be several centimetres across. They can appear anywhere on the body and occur in one in 20 births. These marks commonly appear between one and four weeks after birth; they can then grow quite rapidly before stopping and slowly fading. Fifty per cent of these marks vanish by the age of five, and 90 per cent have gone by the age of nine. Where the hemangioma is blocking vision or breathing (rare), oral medications (known as beta-blockers), surgery, or laser treatment may be recommended.

Port-wine stains (nevi flammeus): These are usually pale pink at birth but become darker red with time, sometimes appearing like the colour of red wine. They typically occur in three in 1000 births. The shape is irregular, and these stains can sometimes be very large. When they occur on the face, they can make people feel self-conscious. Port wine stains are usually considered permanent and will not generally fade, and those around the eye and forehead can be associated with glaucoma. Port wine stains can also occasionally appear with Sturge-Weber syndrome, a rare disorder where abnormalities may also appear in the brain and eyes.

Congenital Dermal Melanocytosis: A bluish, bruise-like, irregular, flat birthmark, Mongolian Spots are typically about 10 cm across and found on the lower back and buttocks. They are most frequently seen among darker-skinned people, particularly among those from East Asia. Mongolian Spots may not appear until sometime after birth, but gradually fade over several years. They have been mistaken for abuse bruises by social workers and health care professionals.

Café au Lait Spots: Most commonly a light brown, milk-coffee colour, and oval to round, these can appear anywhere on the body and usually include only one or two spots. There are no health problems associated with one or two spots, but if there are many of these spots there is a possibility of neurofibromatosis. Café au Lait spots do not fade with age.

Congenital melanocytic nevus: These usually appear as brown to dark-brown marks that may only be slightly raised, although larger ones can be raised and lumpy. They range from less than 1 cm to more than 30 cm and can appear anywhere on the body. Sometimes congenital melanocytic nevi can be hairy. The marks occur in about one in 100 births. It has been suggested by some studies that there is a cancer risk associated with the larger marks. These large visible marks can have a psychological impact. Surgical removal is an option, but will usually lead to scarring. The marks should be watched for any changes that could indicate cancer.