Dealing with Birthmarks

About one-third of all newborns have birthmarks, which are skin discolorations that are present at birth or develop in the first few weeks of life. Birthmarks can appear on any part of the body; vary in shape, size, and depth; and appear as light tan, brown, blue, red, or purple.

Many birthmarks disappear during childhood and don't require treatment. But other birthmarks persist into adulthood and can cause serious emotional distress, especially if they affect the face or another visible part of the body.

Because they are sometimes associated with more serious conditions such as cancer, all birthmarks should be evaluated during a routine well-baby visit. Medical treatments are available for persistent birthmarks, but they may not be covered by insurance.

The Causes of Birthmarks

No one knows exactly why some babies have birthmarks and others don't. Birthmarks can't be prevented, aren't inherited, and aren't related to any environmental exposure during pregnancy.

Doctors divide birthmarks into two main categories:

• Red birthmarks, which are caused by a buildup of blood vessels close to the skin surface.
• Pigmented birthmarks, which are caused by a buildup of pigment that is different from the natural skin color.

The Types of Birthmarks

The most common types of red birthmarks (also known as vascular birthmarks) are:

• Macular (flat) stains, which are faint and mild red or pink. They're known as "angel's kisses" when they appear on the forehead, eyelids, top of the nose, or upper lip; and as "stork bites" when they appear on the back of the neck. Angel's kisses typically disappear by age two, but stork bites usually last into adulthood. Both types are harmless and don't need treatment.
• Hemangiomas, which usually affect the face and neck, but can appear anywhere on the body. Superficial hemangiomas — also known as "strawberry" hemangiomas — are bright red because abnormal blood vessels are close to the skin surface. They're usually not treated, and 95 percent of them disappear by age nine. Deep hemangiomas — also known as "cavernous" hemangiomas — are bluish-purple because abnormal blood vessels are deep below the skin. Although they may disappear by school age, they can last into adulthood and may require treatment if they affect the eyes, nose, mouth, or genitals, or develop hard-to-heal sores.
• Port-wine (nevus flammeus) stains, which are flat; appear pink, red, or purplish; and usually affect the face, neck, arms, or legs. Unlike hemangiomas, port-wine stains expand as a child grows, and they never go away by themselves. Over time, they can become thicker and darker, and develop vascular blebs, which are small blood-vessel growths that bleed easily. Port-wine stains affecting the forehead, eyelids, or both sides of the face are sometimes associated with glaucoma or seizures. Of all the types of birthmarks, port-wine stains are the most psychologically stressful because they can cover large areas of the face and neck.

Pigmented birthmarks include:

• Moles .
• Café-au-lait spots, which resemble coffee mixed with milk.
• Mongolian spots, which are bluish or bruised-looking lesions on the lower back or buttocks, and usually affect darker-skinned people.

Medical Treatment of Birthmarks

There are no effective home treatments for birthmarks. But permanent birthmarks that are large enough to affect your appearance and self-esteem can be concealed with special cosmetics such as Covermark.

Increasingly, doctors are using lasers to treat permanent birthmarks. Yellow-light lasers are particularly effective because they can damage the abnormal blood vessels, causing the birthmark to shrink or even disappear, without damaging the surrounding skin. Treatments such as surgical excision or freezing (cryotherapy) are more likely to cause permanent scarring.

Laser treatments can completely remove macular stains and some hemangiomas. But rapidly growing hemangiomas — especially those affecting the eyes, nose, mouth, or genitals — are usually treated with injected or oral corticosteroids, sometimes in combination with laser therapy. Laser treatments can also occasionally remove port-wine stains, but they usually just lighten the lesions' appearance by 50 percent to 90 percent, and are sometimes totally ineffective.

Although most birthmarks are harmless, there's no question that they can mar your appearance. But recent medical advances, especially in laser technology, have improved the odds that you won't have to live with a birthmark for life.