Vascular birthmarks

What is it?

A vascular birthmark is a discoloration of the skin that is caused by blood vessels that don't form correctly. They are present at birth or appear shortly after birth. There are three major types of vascular birthmarks:

• Salmon patch (nevus simplex) is a flat patch of pink or red skin, often small, usually with poorly defined borders. Salmon patches may be seen in as many as 1 out of every 3 newborns. They typically are found at the nape of the neck (andquot;stork bite"), on the forehead between the eyebrows (andquot;angel's kiss") or on the eyelids. Often, they are more noticeable during crying or changes in temperature.
• Hemangioma is a raised bright red spot, often small, usually soft and compressible, with well-defined borders. It occurs most commonly on the face, scalp, chest or back. It may be present at birth but more often appears during the first month of life. While many hemangiomas will become less noticeable over time, some may grow quite rapidly. In rare instances, the rapidly growing hemangioma can interfere with organ function.
• Port-wine stain (nevus flammeus) is a flat patch of purple or dark red skin, often large, usually with well-defined borders. It usually is on one side of the face or neck and is present at birth. (Mikhail Gorbachev, former president of the Soviet Union, has a port-wine stain on his forehead.) Port-wine stains affect less than 1% of infants. In rare cases, they are associated with other abnormalities.

Symptoms

Vascular birthmarks are painless and usually don't cause any symptoms other than the skin discoloration.

A hemangioma may cause other symptoms if its location interferes with a vital organ. For example, a lesion on the neck could press down on the trachea and interfere with breathing, and a hemangioma near the eye or on the ear could limit vision or affect hearing.

In rare cases, a port-wine stain is associated with other abnormalities. For example, some children who have a stain around the eyelids also have Sturge-Weber syndrome, a condition that is associated with glaucoma, seizures and other problems.

Diagnosis

A doctor can diagnose these birthmarks by looking at them. When hemangiomas or port-wine stains are located in an area that could affect organs beneath them or near them, the doctor may order additional imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).

Expected duration

Salmon patches usually fade within the first year of life. Hemangiomas can get larger for 6 to 12 months, sometimes rapidly. Then the growth stops and the hemangioma eventually shrinks and disappears. Most hemangiomas disappear by the time children are 9 years old. Sometimes a bit of extra loose skin remains in the spot where the hemangioma disappeared. Port-wine stains usually grow in proportion to the body and persist into adulthood. They may darken or thicken and develop tiny bumps.

Prevention

There is no way to prevent vascular birthmarks.

Treatment

No treatment is necessary for salmon patches, which usually fade within the first year of life. For most hemangiomas, the best cosmetic results are achieved when the birthmarks are allowed to go away naturally, without treatment. However, an infant with a hemangioma should be followed closely to be sure that it is not increasing in size.

Hemangiomas that are enlarging can be treated with propranolol. Those that don't respond to propranolol or pose a danger because of interference with a vital organ are treated with oral or injected corticosteroids, laser or surgical removal. Port-wine stains can be covered with opaque cosmetic creams. They also can be removed by laser therapy.

You should discuss treatment options with a dermatologist or plastic surgeon, who has expert experience in treating vascular birthmarks.

When to call a professional

Birthmarks should be evaluated by a doctor soon after they appear and at regular intervals after that, particularly to monitor the growth of hemangiomas.

Prognosis

Salmon patches fade and have no associated problems. The majority of hemangiomas eventually disappear with no associated problems, although some people affected are left with minor skin changes. Laser therapy can remove most port-wine stains with minimal scarring or discoloration. For hemangiomas involving vital organs and port-wine stains associated with other abnormalities, the outlook varies. For the best outcome, seek early evaluation and treatment by an experienced doctor.

Additional info

American Academy of Dermatology
https://www.aad.org/