Birthmarks: to treat or not?

Birthmarks: to treat or not? – includes folklore surrounding them and descriptions of the common ones

Almost one in three children is born with a pink, red or brown skin spot popularly called a birthmark. The vast majority of these blemishes are small and inconspicuous, but a minority need treatment because they’re disfiguring or endanger health.

Most birthmarks are harmless and many fade with time, some disappearing by six to eight years of age. Thanks to advances in laser technology there is now fresh hope for the removal of many that are permanent or unsightly, especially those known as port wine stains.

What are birthmarks?

A birthmark is loosely defined as any spot, stain, swelling or other mark obvious at or within two weeks of birth on a baby’s skin. The term is also loosely used for vascular (blood-filled) lesions such as strawberry marks that show up a bit later. Birthmarks are classified as vascular if they involve blood vessels, melanocytic if they involve pigment-producing cells or epidermal if they affect only surface skin tissue. Birthmarks most often appear on the face, neck, ears or buttocks. They may be small and inconspicuous, large and obvious, occasionally even bizarre. For example, one woman born on December 24th had a spot on her leg shaped exactly like a Christmas tree! While the vast majority are harmless, occasionally the presence of many birthmarks, possibly along with other symptoms, may point to underlying disease.

Corrective make-ups can conceal them

Alternatives for those with birthmarks who cannot or do not wish to undergo laser therapy or other treatment are corrective dermatological make-ups such as Dermablend or Covermark containing titanium dioxide which conceals birthmarks better than ordinary cosmetics. Dermablend, for example, comes in a wide range of shades, suitable for any skin. The product is waterproof and fragrance-free, can be worn for days, bathed in or worn in bed. These corrective make-ups give good skin matching and a natural look, are easy to apply (with special applicators) and non-greasy. They are available in Canada at many large department and drugstore chains or in esthetic salons where they can be tried out. The best results are usually obtained when such cosmetics are specially blended and supplied by a custom cosmetologist or at a cosmetic clinic such as that at the University of Toronto’s Sunnybrook Medical Centre.

Some common birthmarks

Stork bites:

Also popularly known as a salmon mark, this reddish-pink mark at the nape of the neck or on the forehead appears in 30-40 per cent of white-skinned newborns. If the stain shows up on the neck or eyelids, it’s called an angel’s kiss. This harmless little mark, a remnant of fetal capillary (blood vessel) development, is an abnormal collection of surface blood vessels that dilate and cause redness. It almost always fades during the first year of life, although faint signs may remain forever. Those on the eyelids or middle of the head usually disappear by nine months – if not they may need treatment.

Mongolian spots (sacral stains): More a smudge than a spot, this bluish mark, due to a collection of pigment-producing cells, occurs mostly on the lower back or buttocks of newborns. The name is a misnomer because the so-called Mongolian spot is by no means exclusive to or common in Mongols (babies with Down’s syndrome) or among Mongolian races but is most frequent among Blacks, Orientals and Sephardic Jews of Spanish or Portuguese origin. There are no reliable figures on its incidence, but one survey found the Mongolian spot in 50 per cent of black infants. This curious birthmark, which is harmless and fades with time, was first recorded by the Japanese as a “bluespot,” supposedly representing a mark made by Kami-Sama, the goddess of childbirth. It has also been attributed to rubbing of the fetal back against the placenta.

Cafe au lait patches:

Light brown stains made up of pigment-producing cells, seen in about 10 per cent of Caucasian newborns, these birthmarks appear mainly on the trunk and can be any size. Being inconspicuous, they rarely pose a cosmetic problem although they can last a lifetime. More than five cafe au lait spots on a child may signal the presence of an underlying disease, neurofibromatosis (disfiguring, sometimes progressive tumours on the skin or nerves that may require surgery),

Spider angiomas:

These are small, red, wispy spots on the face with networks of fine blood vessels radiating outwards somewhat like a spider’s web. Not strictly speaking birthmarks, they often don’t appear until the age of two to three years and usually fade by puberty. They also sometimes develop in women during pregnancy or in older people and are occasionally left behind after strawberry birthmarks have faded. Generally harmless, large numbers of spidery naevi may signal liver problems or an unsuspected vitamin B deficiency. Some can now be treated with electrical therapy or lightened by tunable dye laser treatment (as with port wine stains).

Port wine stains:

Port wine stains occur at birth, affect 0.3 per cent of babies and come in all shapes and sizes, ranging from small and inconspicuous to large and obvious, on any part of the body, but mostly on the face or neck. Usually permanent and often psychologically disturbing, a port wine stain or naevus flammeus is a malformation of blood vessels just under the skin. This birthmark usually starts off pale pink but gradually darkens until by middle age it becomes a deep reddish purple, possibly with some wart-like skin changes. A mature port wine stain looks as though someone had splashed red wine across the face. Today’s most familia port wine stain crowns Soviet leader Mikhail Gorbachev’s bald forehead. He has doubtless done port wine stain sufferers a great service by displaying the mark without embarrassment. Those on the face are usually confined to one side. The chief complication of port wine marks is the psychological burden of feeling marked,” particularly if the disfigurement is obvious. The resulting feelings of embarrassment might require supportive counselling to boost self-esteem. In a minority of cases, a port wine stain may affect the underlying tissues. Some children with port wine stains on the face have accompanying abnormalities of certain blood vessels in the brain, a congenital condition known as the Sturge-Weber syndrome. In its more serious manifestations, this syndrome can lead to seizures or glaucoma (increased pressure in the eyes). When a port wine stain is large and covers both the cheek and forehead there is a 50 per cent risk of glaucoma. And since about a quarter of infants with port wine stains on the face have symptomless Sturge-Weber syndrome (without any immediately apparent symptoms), experts advise that all children with port wine stains on their faces should have a brain CT Xray) scan and an eye test before the age of six months. Over the decades, many treatments have been tried to erase port wine stains, most meeting with little success. Excision and replacement with a skin graft from another part of the body usually gives a cosmetically poor match, with the risk of scarring. Other treatments, such as carbon dioxide freezing, electrocautery, X-ray therapy or camouflage by tattooing with flesh coloured dyes were generally unsatisfactory, sometimes dangerous, often painful and almost always left scars. Laser therapy has dramatically improved the treatment of port wine stains. Use of the argon laser (for adults) or the newer pulsed tunable dye laser (for children) can often obliterate or lighten port wine birthmarks, leaving little or no scarring. The success of laser treatment depends on the size, depth and location of the birthmark. Properly performed in adults, argon laser treatment is considered good to excellent with effective lightening in about 70-80 per cent of cases although it may leave scars. in children, use of flashlamp-pulsed tunable dye lasers can give excellent results at ages as young as three months. The best time to treat port wine stains is in early childhood in order to avoid psychological hardships in the school years.

Strawberry hemangiomas:

The strawberry mark is the popular name for a bright red or pink, clearly demarcated, raised or domed, spongy, blood-filled skin tumour seen in four to 10 per cent of babies. It purportedly arises because of the arrested embryonic development of a small part of the blood system. Although many regard the strawberry as a classic birthmark, only about 55 per cent are obvious at birth, another 25 per cent show up within a week and the rest up to a month after birth. The strawberry mark usually appears on the head, face or neck, sometimes on the lip, nose or eyelid, less often on the trunk. It can be tiny, only a few millimetres across, but most average two to five centimetres and a few cover a larger area. Strawberry marks affect twice as many girls as boys. Strawberry marks usually grow rapidly until about nine to 12 months of age and then stop expanding and gradually lighten, usually vanishing entirely or fading to a cosmetically acceptable shade by the time a child starts school. The strawberry mark tends to lighten from the centre outwards and the earliest sign of its disappearance is the development of central gray spots. About 50 per cent of strawberry marks disappear by age five, 70 per cent by the age of seven and 90 per cent by the time a child is nine years old.

Most experts recommend no treatment for strawberry marks. Parents are advised to “watch and wait” for them to fade or disappear. But the long wait can be worrisome and many parents are upset by the blemish, especially a large or disfiguring one. For instance, some give the nose an alarming, bulbous, swollen look – the “Cyrano nose.” Seeing “before” and “after” photos of strawberry marks that have faded by themselves can encourage patience. But plastic surgeons and dermatologists may have a tough time convincing parents that the birthmark will almost certainly vanish on its own, and when surgeons are persuaded to operate rather than wait for the fading, the result is often lifelong scars.

A small proportion of strawberry marks fail to lighten or get smaller, leaving some residual skin wrinkling or a pinkish tinge. Very rarely, complications arise from strawberry marks that become infected, ulcerated, bleed or cause irreversible facial distortion. Strawberry marks near the mouth may impede feeding, those on the eyelid may obscure vision and need treatment. Large strawberry marks on the eyelid or in the ear can lead to medical problems. In such cases, steroid therapy – taking prednisone for a short time – may be the solution. But because of its potential side effects in young children (slowed growth and possible immune system suppression) only those at serious risk from their strawberry birthmarks are given steroid therapy.

Folklore surrounds birthmarks

No one knows exactly what causes birthmarks. They are generally believed to be remnants from embryonic tissue differentiation. Most are not hereditary, although some occur more frequently in people with specific skin colours – such as blue” or Mongolian” spots in Orientals. Birthmarks are not of dietary origin. Babies do not, as some used to believe, have red birthmarks because their mothers ate tomatoes or beetroots while pregnant! Nor do birthmarks result from shock or exposure to environmental toxins. Nonetheless, myths abound. Red birthmarks which look like blood stains have long been regarded as signs of a violent character or untimely death, and according to European folklore, birthmarks often arose from a mother’s strong feelings during pregnancy. The belief was that if an expectant mother became excessively disturbed or frightened her distress would forever “mark” the child in her womb. Another common misconception was that if women were denied some especially craved food during pregnancy, their babies would be born blemished. Accordingly, in France, a birthmark is called envie (desire), in Italy it’s termed a voglia (wish or craving). The idea of a link between food and birthmarks (feed a woman what she wants or her child will be deformed) might have evolved in order to help pregnant women secure a sufficient supply of sometimes scarce proteins, vitamins and minerals.

COPYRIGHT 1990 Strategic Inc. Communications Ltd.

COPYRIGHT 2004 Gale Group