What to know about birthmarks
Very few birthmarks cause significant medical problems. Although some people request surgery to remove birthmarks, few of these procedures occur due to medical necessity.
In this article, we cover several types of birthmarks and their causes, as well as possible complications of a birthmark and treatments to reduce their risk of becoming harmful.
A birthmark is a blemish on the skin that is visible from birth or shortly afterward.
Researchers do not yet fully understand why some babies have birthmarks and others do not.
That said, some have hypothesized that a buildup of cells that line the blood vessels of infants may cause strawberry marks to occur.
Some doctors believe that a tiny piece of placenta may become lodged inside the developing embryo very early on in the pregnancy.
If damage occurs to the nerves that control the widening or narrowing of capillaries, there is a chance of port-wine stains, especially if the capillaries permanently widen in one area.
Also, many experts believe that some proteins produced by the placenta during pregnancy may be linked to a higher chance of developing some types of birthmark.
Abnormal blood vessels under the skin cause vascular birthmarks, which form a red, pink, or purple blemish. In the following slides, we discuss the different types of vascular birthmark.
A hemangioma, or a "strawberry mark," is a red, raised mark on the surface of the skin. Many are initially small and flat.
It is impossible to know whether or not a hemangioma will grow later on. Usually, they grow quickly during the baby's first 4–5 months of life. After this, the growth rate of the birthmark slows down, and it many eventually fade.
For some infants, the skin may become stretched or deformed, especially if the mark is large.
Telangiectatic nevus birthmarks have numerous other names, including nevus simplex, salmon patch, stork mark, and stork bite. They occur due to the expansion and buildup of tiny blood vessels in the skin.
Telangiectatic nevus shows as slightly reddened skin. When it occurs on the face, some people call it an "angel kiss." This type will usually fade within a couple of years, but it may become visible when a child cries.
When telangiectatic nevus occurs on the back of the neck, some people call it a stork mark. Stork marks may remain visible, but hair usually covers them.
These are red or purple marks that commonly develop on the face but can occur anywhere on the body. The abnormal leaking of blood vessels in the affected area causes port-wine stains. They may vary in size from a few millimeters to several centimeters.
Without treatment, they may eventually get darker.
Some babies have pigmented birthmarks, which are usually brown, from birth. The clustering of pigment cells causes these types of birthmark. In the next slides, we describe several types of pigmented birthmark.
Café au lait spot
These are usually oval in shape and light brown.
These marks are either present from birth or develop soon afterward. As people get older, the marks do not fade. Some people may have one or two, but more may occur in some people.
People with more than four cafe au lait birthmarks may have neurofibromatosis, a genetically inherited condition in which the nerve tissue grows tumors. These growths may be harmless but can sometimes cause serious damage by putting pressure on the nerves and other tissues.
Congenital melanocytic nevus
Image credit: M. Sand, et al., 4 June 2010
These birthmarks can occur in any part of the body.
This type of birthmark is usually light brown on light skin. People with darker skin might experience congenital melanocytic nevus as an almost black mark.
It can have an irregular shape and may be flat, raised, or lumpy. They are relatively large brown or black moles. As the baby grows, the marks become proportionally smaller.
Sometimes, they may darken or develop hair during puberty.
A small birthmark of this type is not a cause for medical concern.
Congenital dermal melanocytosis
Image credit: Gzzz, 2 May 2014
These are blue-gray marks that are more common in people with darker skin. The mark may appear bruise-like and develop on the lower back or buttocks.
These are harmless and will usually fade by the time a child is about 4 years old.
Image credit: Dr. Gary White, http://www.regionalderm.com/index.html
Parents can pass this birthmark onto their children in the genes. It presents as a silver streak of hair that usually develops at the right or left side where the forehead and hairline meet.
The vast majority of birthmarks pose no long term health problems. Many of them eventually fade away.
That being said, some birthmarks, including strawberry marks, may turn into an open sore and develop an infection if they are in an area that is frequently irritated.
A child with a strawberry mark on the eyelid requires prompt treatment, otherwise their risk of experiencing vision problems increases.
Likewise, a strawberry mark that interferes with breathing or feeding may be life threatening and requires rapid treatment.
Very rarely, port-wine stains can occur due to Sturge–Weber syndrome, a condition of the blood vessels that affects the eyes, brain, and skin.
Laser surgery is an option for treating a birthmark.
A significant number of birthmarks fade away without treatment.
However, if the birthmark causes health problems, or if a person feels strongly about getting rid of it, a doctor may recommend treatment.
Treatment can sometimes be painful, and it is not always effective. Unless a birthmark causes problems with sight, feeding, hearing, or breathing, caregivers should try to weigh the potential risks of treatment with the anticipated benefits for the child. Not all birthmarks are treatable.
A doctor can usually make a fairly accurate prediction of how a child's birthmark will progress. If they believe that a birthmark requires treatment, they may suggest one of the following options:
- Propranolol: A doctor may prescribe this for an infant to take by mouth. It helps prevent the further development of hemangiomas by narrowing the existing blood vessels and preventing new ones from forming.
- Corticosteroids: Doctors can inject corticosteroids into some types of birthmark, or an infant can take them orally. This can help shrink certain birthmarks or prevent any further growth.
- Interferon alpha-12: If a corticosteroid does not have the desired effect, a doctor may suggest this medication instead.
- Laser therapy: Doctors commonly use this type of therapy for port-wine stains and other birthmarks that are close to the skin's surface.
- Surgery: If other therapies are not effective and the birthmark is causing a medical problem, a doctor may recommend surgery.
Treatment options depend on several factors, including the type, location, and severity of the birthmark.
However, the majority of birthmarks do not cause health problems and will fade over time.
Is birthmark removal covered by insurance if there is no medical risk?
Health insurance does not typically cover birthmark removal for cosmetic reasons alone. There may be exceptions for certain large, prominent birthmarks in locations such as the face.
As many birthmarks change during childhood, often becoming smaller or lighter, waiting until adolescence or adulthood to decide on cosmetic treatment may be the best option.Karen Gill, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.