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Birthmarks Content Supplied by NHS Choices
Introduction

Birthmarks are coloured marks that are visible on the skin. They're often present at birth or develop soon afterwards.

There are several different types of birthmark and some of them are very common.

The two main types of birthmark are:

  • vascular birthmarks (often red, pink or purple) caused by abnormal blood vessels in or under the skin
  • pigmented birthmarks (usually brown) caused by clusters of pigment cells

Vascular birthmarks often occur in the head and neck area, mainly on the face. However, both types of birthmark can appear anywhere, including inside the body.

If surface blood vessels are affected, a vascular birthmark will appear red, purple or pink. If the affected vessels are deep, the birthmark will appear blue.

Pigmented birthmarks are tan or brown-coloured skin marks.

Vascular birthmarks

Some of the most common types of vascular birthmarks are described below.

Salmon patch (stork mark)

Salmon patches are red or pink flat patches that can appear on a baby's eyelids, neck or forehead at birth.

They're the most common type of vascular birthmark and occur in around half of all babies.

Most salmon patches will fade completely within a few months, but if they occur on the forehead they may take up to four years to disappear.

Patches on the back of the neck can last longer. They're often more noticeable when a baby cries.

Infantile haemangioma

Infantile haemangiomas are raised marks on the skin that are usually red. They can appear anywhere on the body. They're also known as strawberry marks.

Sometimes infantile haemangiomas occur deeper in the skin, in which case the skin can look blue or purple.

Haemangiomas are common, particularly in girls, and affect around 5% of babies soon after birth. They rapidly increase in size for the first six months before eventually shrinking and disappearing by around seven years of age.

Haemangiomas that get bigger rapidly or those that get in the way of vision or feeding may need to be treated.

Port wine stain

Port wine stains are flat red or purple marks that affect a very small number of newborn babies. They can vary in size, from a few millimetres to several centimetres in diameter.

Port wine stains often affect one side of the body and usually occur on the face, chest and back (although they can occur anywhere).

They tend to be sensitive to hormones and may become more noticeable around puberty, pregnancy and the menopause. Most are permanent and may deepen in colour over time.

Pigmented birthmarks

Some of the most common types of pigmented birthmarks are described below.

Café-au-lait spots

Café-au-lait spots are coffee-coloured skin patches. Many children have one or two, but if more than six have developed by the time the child is five, you should see your GP. This could be a sign of neurofibromatosis (a number of genetic conditions that cause tumours to grow along your nerves).

Mongolian spots

Mongolian spots are blue-grey or bruised-looking birthmarks that are present from birth.

They're more commonly seen in darker-skinned people and usually occur over the lower back or buttocks. However, they can also appear elsewhere on the body or limbs.

Mongolian spots may last for months or years, but they usually disappear by the time a child reaches four years of age. They're completely harmless and don't need treatment. They may sometimes be mistaken for a bruise.

Congenital melanocytic naevi

Congenital melanocytic naevi are also known as congenital moles. They are relatively large brown or black moles that are present from birth.

They're fairly common and are caused by an overgrowth of pigment cells in the skin. Most congenital melanocytic naevi become proportionally smaller and less obvious with time, although they may darken during puberty or become bumpy or hairy.

They can range in size from less than 1.5cm (about 0.6 inches) to more than 20cm (about 7.9 inches) in diameter. The risk of a naevi developing into skin cancer is low, but the risk increases the larger it is.

What causes birthmarks

It's not fully understood why birthmarks occur, but they're not usually inherited. Vascular birthmarks are caused by abnormal blood vessels in or under the skin, and pigmented birthmarks are caused by clusters of pigment cells.

It's thought that port wine stains occur because the nerves that control the widening or narrowing of the capillaries (tiny blood vessels) don't function properly, or there aren't enough of them. This means that blood is constantly supplied to the skin in that area, which makes it permanently red or purple in colour.

Port wine stains are sometimes related to other conditions, such as Sturge-Weber syndrome and Klippel-Trenaunay syndrome.

Read more about the complications associated with birthmarks.

Treating birthmarks

Most birthmarks are harmless and don't need to be treated. Some types of birthmarks will fade over time, whereas other types such as port wine stains will be permanent if they're not treated.

In some cases, a birthmark will need to be treated for medical reasons - for example, if a haemangioma blocks the airways, affects vision or becomes ulcerated. Some people may seek treatment for cosmetic reasons.

Read more about treating birthmarks.

Treating birthmarks

Most birthmarks are harmless and some disappear without treatment.

Some types of birthmark may need to be treated for medical reasons, while some people may choose to have them treated for cosmetic reasons.

Haemangiomas

Some haemangiomas will disappear without treatment, but they often don't change until your child is two years old.

Haemangiomas will sometimes disappear by the time a child reaches five years of age. In other cases, they may last until a child is 12.

Plastic surgery may be an option if a haemangioma has left the skin deformed or stretched. The aim of surgery will be to improve the appearance of the distorted skin.

If the haemangioma has formed an ulcer, you may need to take extra measures to prevent infection, and surgery or laser treatment may be offered.

Read more information about the complications of birthmarks.

Large or complicated haemangiomas

Some haemangiomas may cause complications that will need treatment.

A haemangioma near your child's eye, nose or mouth may cause vision, breathing or feeding problems.

Haemangiomas on the lip or around the nappy area are more likely to form ulcers that can sometimes bleed and be painful.

The exact treatment will depend on where and how severe the haemangioma is. Most haemangiomas can be effectively treated with medicine, such as oral propranolol in liquid form. This will shrink the birthmark.

If propranolol doesn't work, other medicines can be used, such as steroids or vincristine. Surgery is rarely necessary.

If your child has breathing difficulties caused by a haemangioma in their airway, they may need laser treatment.

This will usually be carried out during an examination of their airway using a small telescope called an endoscope. The procedure is known as microlaryngoscopy and bronchoscopy. They may also be given propranolol.

Occasionally, a child with an airway haemangioma may need to have a temporary tracheostomy (an artificial opening in the windpipe) to improve their breathing.

Propranolol

Medication may be recommended if the haemangioma is complicated or large. This is usually a beta-blocker called propranolol. The full side effects of using propranolol to treat a haemangioma are still being monitored.

Beta-blockers work by blocking the release of noradrenaline in certain parts of the body. Noradrenaline is a chemical released by nerves when they're stimulated. The noradrenaline passes messages to other parts of the body, such as the muscles, blood vessels and heart.

It's thought that propranolol helps narrow the blood vessels, reducing the amount of blood flowing through them. This reduces the colour of the haemangioma and makes it softer. The cells that cause the haemangioma to grow are also affected so that the haemangioma gets smaller.

Haemangiomas often leave a patch of stretched and thinned skin, with a small amount of swelling of the tissues under the skin. This is barely noticeable in most areas.

However, in some areas, such as the nose, lips, ears and cheek, these small changes can be unsightly. In these areas, treatment with propranalol may be considered in the first few weeks of life, immediately after the haemangioma has been diagnosed, so that the long-term appearance can be improved.

Monitoring internal haemangiomas

If your child has a haemangioma in an internal organ, they may need an ultrasound scan or magnetic resonance imaging (MRI) scan to confirm its location and size. MRI scans use a magnetic field and radio waves to produce detailed pictures of the inside of the body.

Port wine stains

Port wine stains are permanent. However, some treatments help fade the mark, making it less noticeable. You can also disguise it using cosmetics.

Laser treatment

Laser treatment is the only treatment for a port wine stain. It lightens the affected area of skin. Laser treatment often works better in younger children because in adults a port wine stain may become bumpy and raised after a number of years.

The most common type of laser treatment is known as pulsed dye laser treatment. The laser passes through a fibreoptic cable. On the end of the cable is a device that looks like a pen. This is gently held against the surface of your child's skin and a button is pressed, which sends a beam of light to the skin.

The light goes less than 1mm into the skin. It's absorbed by the blood vessel just beneath the surface, causing it to heat up. The heat damages the blood vessel, which creates a bruise that will fade within a week or two.

During or after treatment, your child's skin will be cooled to reduce discomfort, or a jet of cold air might be blown onto the skin during treatment.

Some of the possible side effects of laser treatment are described below.

  • bruising - after some types of laser treatment, it's normal for the mark on the skin to look worse because of bruising, but this will fade after one to two weeks
  • pain - the laser stings, so most children have laser treatment under general anaesthetic (where they are put to sleep), but some children can tolerate treatment with the help of a local anaesthetic cream that numbs the skin; a cold gel pad may also be put on the area before treatment to minimise any discomfort
  • increased sensitivity to sunlight - your child's skin will be very prone to sunburn for up to six months after laser treatment

Between 3 and 30 treatment sessions may be needed at intervals of six to eight weeks.

How effective the treatment is depends on how prominent and dark the affected area is. The best results are often seen in marks that are already smaller and lighter.

Camouflage make-up

You can get a prescription for a special type of camouflage make-up that covers up the birthmark.

The charity Changing Faces now runs the skin camouflage service previously run by the Red Cross. You can book an appointment with a trained volunteer, who can teach you to apply the make-up.

You can read more about skin camouflage on the websites of the British Association of Skin Camouflage and the Skin Camouflage Network.

Congenital melanocytic naevi (CMN)

As congenital melanocytic naevi (CMN) can affect a person's appearance, surgery may be considered. However, surgery will leave scarring and may not be possible if the affected area is very large.

Surgery involves removing the birthmark and stitching together the edges of the skin. If the area is large, a skin graft may be needed. This involves taking skin from another part of the body and using it to cover the wound.

Read more about how skin grafts are performed.

Complications associated with birthmarks

Most birthmarks are harmless. However, in rare cases, complications can occur that need to be treated.

Haemangiomas

Although it's rare, some haemangiomas can cause severe problems and can even be life threatening. They need to be treated if they interfere with eating, breathing or eyesight.

Read more about treating birthmarks.

If your child has a haemangioma near their eye, nose, mouth or nappy area, they may need to be referred to a specialist. Haemangiomas in these areas are more likely to become infected. If the birthmark bleeds, apply pressure to it until the bleeding stops.

See your GP if your child's haemangioma forms an ulcer. It may become infected and be very painful. Keep the wound clean and covered with a dressing. It should heal within two weeks.

Infected haemangiomas need urgent treatment with antibiotics. An infected ulcer may leave an unsightly scar.

If your child has more than five haemangiomas, they may also have internal haemangiomas. An ultrasound scan or magnetic resonance imaging (MRI) scan may be used to find out whether any internal haemangiomas are present.

It's very unusual for internal haemangiomas to cause problems. However, very rarely they may cause coughing and difficulty breathing, which may indicate airway haemangiomas. Another possible symptom is blood in the stools, which may indicate haemangiomas in the bowel.

Port wine stains

Port wine stains can lead to the complications outlined below.

  • glaucoma (raised pressure within the eye that affects vision) - this may develop if the birthmark affects both the upper and lower eyelids on the same side
  • Sturge-Weber syndrome - a rare disorder affecting the eyes and brain that is usually associated with a large port wine stain that extends across the forehead or scalp (find out more about the condition on the NINDS website)
  • soft tissue hypertrophy (the tissue beneath the birthmark enlarging) - this may occur on the lip, for example
  • Klippel-Trenaunay syndrome - a rare disorder that's present at birth where the blood vessels fail to form properly; if your child has an enlarged port wine stain on their limb, they may have Klippel-Trenaunay syndrome (see the NINDS website for more information)

All of the above conditions will need to be treated by a specialist.

Congenital melanocytic naevi

If a congenital melanocytic naevi increases in size or changes shape or colour, your doctor may recommend that you have a biopsy. This is where a tissue sample is taken so that it can be examined under a microscope.

You should see your doctor if you notice any of the following changes in your birthmark:

  • bleeding
  • inflammation (swelling)
  • itching
  • open sores
  • pain
  • changes in colour, size or texture

Although it's very rare, some congenital melanocytic naevi can develop into skin cancer. This risk increases with the size of the birthmark - the larger it is, the greater the risk.

Read more about moles.

 
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