About birthmarks
Dear Dr Persadsingh,
My child has a birthmark on his face. I would like to know what to do about it. I feel embarrassed and upset about it. Children at his school often tease him about it. Please help me.
Birthmarks are flat areas or raised discoloured skin which may be seen on the body at birth or which may develop after birth.
The cause is unknown, and old wives’ tales should not be taken seriously. Birthmarks are not caused by anything that may happen to the woman while she is pregnant.
Birthmarks may vary in colour — they may be brown or black, blue, pink or red. Some birthmarks are seen as only stains on the skin, others may extend into the tissues under the skin or grow above the surface of the skin.
Some birthmarks may grow with the child and not change in colour throughout their lifetime, but some fade with time, while others darken with time.
Most birthmarks are harmless, though some troublesome marks may need treatment.
They are grouped into pigmented or vascular lesions.
Pigmented birthmarks
Pigmented birthmarks that are flat and coloured include moles, café-au-lait spots and Mongolian spots.
Moles, called congenital nevi, are present at birth, and they may be brown or black in colour and may be located anywhere on the body. They can vary in size and may be raised or flat. Moles with irregular colour or irregular borders, a rough surface, or bleeding should be seen by a dermatologist.
Large moles, especially in the midline, on the back, and on the scalp, should be evaluated by a dermatologist. We can always remove the mole surgically in the dermatologist’s office.
Café-au-lait spots may be tan or light brown patches which result from too much pigment in the skin. About 20 per cent of people have these spots. These spots may fade over time. A single spot is not serious but many spots could indicate other health problems and you should see a dermatologist about them.
Mongolian spots are flat discolourations found on the back or buttocks of the child with dark skin. Most of these will fade completely without treatment.
Vascular birthmarks
These are caused by an increase in the number of blood vessels under the skin. The most common ones are salmon patches, haemangiomas and port wine stains.
Salmon patches are the most common vascular birthmarks. They are usually flat, may be red or pink and are called angel kisses. These are usually seen on the forehead, eyelid, nose or upper lip and usually go away by the time the child is two years old. If they appear on the back of the neck, they are called stork bites and these may last into adulthood. Salmon patches are harmless and need no treatment.
Haemangiomas are a benign growth of blood vessels. There are two types: superficial, that is strawberry haemangiomas; and deep haemangiomas, which are carvernous haemangiomas.
Superficial haemangiomas are raised and bright red and this is because the abnormal blood vessels are close to the skin surface.
The deep haemangiomas have a bluish colour because the abnormal blood vessels are deeper into the skin.
Deep haemangiomas may not be seen at birth but develop during the first six to nine months of life and may improve in appearance over several years.
Most haemangiomas stop growing after the first year. Fifty per cent of them resolve by age five while 90 per cent are flat by age nine. Some changes may remain on the skin after complete resolution of the haemangiomas.
The most commonly used treatments for haemangiomas are observation, steroids and surgery. Laser treatment may be used to shrink the haemangiomas.
Port wine stains appear at birth and are flat. They may be, pink, red or cocoa dust discolourations of the skin They are often found on the face. Unlike other birthmarks, these grow as the child grows. Although the texture and shade may change, these port wine stains are permanent, unless treated. Cosmetics may reduce the appearance of the port wine stains and laser treatment using a pulse dye laser will help.
Birthmarks may cause psychological and social distress for both parents and children. It is normal for parents to feel a variety of emotions, including panic, sadness, guilt and disbelief. Even when you tell the parents that the birthmark will go away, it is not good news to them, especially when the child’s appearance may seem unflawed at birth.
Dealing with the reactions of strangers can be stressful when you are faced with stares and questions about your child’s birthmark, but parents, please try and be supportive of the child.
Dr Persadsingh is a skin specialist and author of Acne in Black Women, The Hair in Black Women and Eczema in Kids of Colour.
