What are the different types of birthmarks, and can you tell us a bit about strawberry birthmarks?

Birthmarks are extremely common, affecting up to four out of five babies. The majority occur as a minor developmental imperfection of the skin and are completely harmless to the baby’s health. They appear in various shapes, sizes and colours depending on the tissues (cells) involved.

Vascular (blood vessel birthmarks) include the stork mark [salmon patch or angel’s kiss], port wine stains and haemangiomas (strawberry marks). The stork mark is the most common (one in five babies) and is seen as a flat red mark on the skin on the upper eyelids, mid-forehead and on the back of the neck. Port wine stains [capillary malformations] affect three in a thousand babies and are flat red areas of skin which can occur anywhere on the body, often seen on one side of the face.

Haemangiomas [strawberry mark] affect one in ten babies and may be present at birth as a pale or pink area of skin, but often they become apparent during the first week of life as a red or purple lump which rapidly grows over a three to six month period. Thereafter it slowly regresses spontaneously and eventually will disappear almost completely in three to seven years. For the majority of haemangiomas no treatment is necessary; however, they can potentially pose a problem at certain sites on the body, for example around the eye or internally in the airway, and the treatment of choice for these babies is a drug called propranolol which is administered as a medicine. A less common presentation is an extensive more flat haemangioma, referred to as segmental, often on the face or limb, which can be associated with internal blood vessel abnormalities and requires further investigation and if appropriate treatment

Pigmented (brown) birthmarks include mongolian blue spots which are very commonly seen in Asian and African skin as a blue-grey discolouration often on the lower back and buttocks. A café au lait spot (or macule) may occur anywhere on the body. They are most commonly oval in shape and light brown, or milk coffee in colour. Moles (congenital melanocytic naevi) are visible on one in a hundred newborns. They range in size and colour, usually light brown in fair-skinned babies and almost black in darker-skinned babies.

Why do birthmarks appear, are they inherited?

The most common causes are abnormal blood vessels (vascular birthmarks) or pigment cells forming in clusters (pigmented birthmarks). As visible marks on the skin, they range from pink to dark brown, develop during pregnancy and are present at or soon after birth.

When should parents be concerned about birthmarks?

For most birthmarks nothing needs to be done apart from reassurance, however some may require further investigation and treatment. In rare cases, certain birthmarks can be associated with more serious medical complications and in these cases early intervention is important.

If a birthmark is unsightly, am I able to get treatment for my child, and what are the procedures available?

The Portland is proud to be leading the way with a pioneering new birthmark treatment using propranolol. This has replaced the traditional treatment for haemangiomas which until now has been steroids. Propranolol is a beta-blocker which was recently discovered to rapidly shrink infantile haemangiomas. The reason it works is not clear, but it has been shown to be highly effective and is now recognised to be the treatment of choice for haemangiomas requiring systemic treatment. The aim of early treatment is to prevent the complications of haemangiomas, for example those around the eye which may cause significant visual problems if left untreated. Prior to starting propranolol treatment the child needs to be carefully screened, in particular the cardiovascular system. The commencement of propranolol is administered on the Day Case Unit where the blood pressure and heart rate are monitored over a 2 hour period. This has the benefit of full clinical back up in the unlikely event of an adverse reaction. Thereafter the child will need weekly monitoring locally and regular review. Normally treatment is continued until around the age of one year.

The arrival of the state of the art vascular pulsed dye laser, the Vbeam Perfecta® [Syneron-Candela] at the Portland is a valuable addition to the development of the Birthmark Service. The laser provides treatment for vascular skin lesions, in particular port wine stains, telangiectasia (spider naevi) and ulcerated haemangiomas. Facilities are available for both general anaesthesia and local anaesthesia, depending on the age of the child and the size of the vascular lesion. For most children treatment of a port wine stain starts when the child is around one year old and is performed under general anaesthesia (GA). The child will be admitted to the Day Case Unit and the GA administered by a Consultant in Paediatric Anaesthesia. A typical port wine stain will require four to six laser treatment sessions at three to six laser monthly intervals.

The Portland Hospital for Women and Children
205 – 209 Great Portland Street
London 
W1W 5AH 
Telephone +44 (0)20 3468 0409
Fax 020 7390 8012

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