About birthmarks
Birthmarks are flat or raised discoloured areas which may be seen on the skin at birth or may develop afterwards. They are identified as pigmented or vascular legions. The causes of birthmarks are unknown although there are many old wives’ tales and folk tales which will give the causes for these marks. These should not be taken seriously. Birthmarks are not caused by anything that might have occurred during pregnancy.
Birthmarks vary in colour. They may be brown, black, blue, pink or red. Some are seen as only stains on the skin. Some may extend into the tissue under the skin and some may grow above the surface of the skin. Some birthmarks may grow with the child and do not change in colour throughout their lifetime. Some fade with time and some may darken with time. Most birthmarks are harmless although some may need medical treatment.
Pigmented birthmarks
Birthmarks which are flat and coloured include moles, café-au-lait and Mongolian spots.
Moles, also called congenital nevi, are present at birth and are brown or black in colour and may be located anywhere on the body. They vary in size and may be raised or flat. Moles which bleed, have an irregular colour, irregular borders or a rough surface should be seen by a dermatologist. Large moles especially in the middle of the back and on the scalp should be evaluated by a dermatologist. These can be surgically removed as an office procedure.
Café-au-lait spots may be tan or light brown patches which result from too much pigment in the skin. These may fade over time. A single spot is not cause for concern but many spots could indicate other health problems and should be seen by a dermatologist.
Mongolian spots are discolourations found on the back and 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 called salmon patches, haemangoimas and port wine stains.
Salmon patches are the most common vascular birthmarks. They are usually flat, red or pink in colour and are also called angel kisses. They are seen on the forehead, eyelid, nose or upper lip and usually go away by the time the child is two years old. Sometimes they will appear on the back of the neck and will last into adulthood. Salmon patches are harmless and need no treatment.
Haemangiomas are benign growth of blood vessels. There are two types — superficial, also called strawberry Haemangiomas, and deep Haemangiomas, also called cavernous Haemangiomas.
Superficial Haemangiomas are raised and bright red. This is because the abnormal blood vessels are close to the surface of the skin.
Deep Haemangiomas are bluish in colour. This is because the abnormal blood vessels go deeper into the skin.
Deep Haemangiomas may not be present at birth but develop between six to nine months of age. Most Haemangiomas will stop growing after the first year, and 50 per cent of them will resolve by age five while 90 per cent are flat by age nine. Some textural changes may remain on the skin after complete resolution of the Haemangiomas. The most commonly used treatments for Haemangiomas are observation, steroids and surgery.
Port wine stains appear at birth and are pink, red or cocoa dust discoloured and are mostly found on the face. Unlike other birthmarks, these grow as the child grows, although the texture and shade may change. These can be treated with a pulse dye laser.
Birthmarks may cause psychological and social distress to both parents and children. Dealing with stares and questions from strangers can be stressful, but please be supportive of the child.
Dr Neil Persadsingh is a dermatologist author of The Hair in Black Women, Acne in Black Women and Eczema in Kids of Colour.
