Birthmarks - Causes, Types, and Treatment

What Is a Birthmark?

A birthmark is a pigmented mark on the skin surface seen during birth or develops soon after birth. Birthmarks become more prominent or fade over time and are mostly painless and harmless. When a birthmark is painful, it breaks open, overgrows, or changes color then consult a dermatologist. The skin of the birthmark is as healthy as other normal skin.

What Causes a Birthmark?

The exact cause of the birthmark is not known. However, the following may be the cause of birthmarks;

1. Genetically inherited.

2. Blood vessels are not formed properly.

3. Accumulation of melanin (natural skin pigment).

4. Overgrowth of skin.

5. Other conditions include premature delivery, less than 5 1/2 pounds at birth, and white females.

How to Differentiate Birthmarks?

There are different types of birthmarks; including,

• Mongolian Spots - The birthmark appears blue,irregular, and has one or more flat patches. The most common site include the lower back or buttocks, and these birthmarks fade by 3 to 5 years old.

• Strawberry Mark - It looks like a raised, firm, and rubbery lump and in strawberry-like color. The mark may be found on the moist tissue inside the mouth or anus, face, or near the eye (if the eye is involved, it may affect normal vision). It appears at around 1 to 4 weeks of age, stops growing between six to 12 months, and gradually disappears over the next few years.

• Salmon Patch - When the birthmark is present on the face, it is referred to as anangel’s kiss. When on the back of the neck, it is referred to as a stork’s bite. It may appear pink, red, or salmon-colored (when gently pressed on this birthmark, the color fades. The color becomes more prominent when the baby cries, becomes overheated, or feels irritated). They are flat and irregularly shaped, present over the nape of the neck, eyelids, forehead, sides of the nose, and on the top lip. They usually disappear between 1 to 3 years.

• Café au lait Spots - They appear light brown (milk-coffee colored), dark brown (black coffee), and flat spot with well-defined borders and are roughly oval-shaped. These spots appear over the buttocks and are present at birth or in early childhood; they remain on the skin for life.

• Port-wine Stain - These stains are pink or purple and appear flat, with clear edges, and are caused by abnormally formed and dilated veins. These birthmarks appear thick and lumpier around and after puberty and mostly over the jaw, cheek, tongue, and lips. On the face, these stains appear on one side at birth; the color gets darker (from pale pink to deep red-purple) as the child grows and remains on the skin for life.

• Nevus Sebaceous - Birthmark changes color to slightly yellow or orange. It is characterized as a slightly raised, hairless (or nearly hairless) patch and feels pebbly or warty on the touch and appears on the scalp of a newborn. As the child grows, this birthmark may remain the same or change during the teenage. In addition, it may thicken, but it does not go away.

• Moles - Inborn moles appear as brown spots at birth or in the first year of life. Acquired moles are more common and develop around 2 years. They look large dark brown, blue, or black birthmarks and sometimes grow dark hairs. In addition, a few fade, but most remain on the skin for life.

• Deep Hemangioma - Skin-colored or bluish-purple birthmark with thin red lines visible with lump on deep skin. These hemangiomas are warm, farm, and show intermittent slow or fast growth. 50 % of them fade in 5 years and 90% in 10 years. In addition, they leave a light spot or scar on fading.

• White Spot - They appear less in color than the surrounding skin. The white spots are raised or flat, round, oval, and sometimes leaf-shaped. The most common site include the chest, abdomen, back, or buttocks, and they disappear.

What Does Birthmark Tell?

Birthmarks sometimes indicate an underlying disease such as,

• Mucopolysaccharidosis, Niemann-Pick disease - Mongolian spots.

• Nova syndrome – Salmon patches.

• Neurofibromatosis, McCune-Albright syndrome, Noonan syndrome, tuberous sclerosis - Café au lait spots.

• Sturge-Weber syndrome, Klippel-Trenaunay-Weber syndrome – symptoms include a port-wine-stain birthmark.

What Are the Treatment Options?

Treatment varies depending on the type of birthmark and clinical presentation.

1. Watch the birthmark and consult a dermatologist when changes are seen.

2. Makeup: a right makeup can cover discolored skin.

3. Heart disease drugs and steroids.

4. Interferon.

5. Surgery to remove the birthmark.

6. Laser therapy.

7. Photodynamic therapy.

8. Sclerotherapy.

Surgery to Remove the Birthmark:

It involves surgically cutting the birthmark that develops into skin cancer. It is also helpful for treating a large raised birthmark that does not fade on its own and affects esthetics.

Laser Therapy:

Lasers produce high-intensity light beams that selectively heats blood vessels. Lasers target the specified blood vessel without damaging the surrounding tissues resulting in less scar formation.

Photodynamic Therapy:

Photodynamic therapy uses a large panel LED. Purple lesions located on the forehead, cheek, and jaw showed superior responses to PDT. Photodynamic therapy is safe and productive with a high depth of penetration.

Light beams used in photodynamic treatment include,

• High-energy pulsed dye laser (PDL).

• LP Alexandrite.

• LP Nd: YAG.

Intense Pulsed Light Therapy:

Intense pulsed light (IPL) is used for PDL-resistant patients or when PDL is unavailable and penetrates deeper than PDL. Patients undergoing any light therapies have generalized photosensitivity. Depending on the photosensitizer used, it is advised not to expose to the sun for days or even weeks.

Sclerotherapy:

Sclerotherapy treats venous malformations and lymphatic malformations like port-wine stains. Injecting a solution into the abnormal veins irritates the vessel wall resulting in a blood clot. These blood clots stop the blood flow making the blood vessel die and eventually replace it with scar tissue.

Conclusion:

Seeing a birthmark on a newborn’s skin can be worrying. Here’s what dermatologists recommend if your child has a birthmark:

1. Ask a dermatologist to help inspect the birthmark as the dermatologist can explain the type of birthmark and if it needs any corrections.

2. Know that most birthmarks are inoffensive, so leave them undisturbed. If there is a concern about the appearance, visit a dermatologist.

Wait and watch for any changes in the birthmark as the child grows.