Birthmarks are seen at birth or shortly after with some appearing during the teenage years. There are two types of birthmarks
- The red or vascular birthmarks
- The brown or pigmented birthmarks
Generally, birthmark will continue to grow from birth till adulthood when it stabilises. Most do not require treatment except for cosmetic concerns. However, in some, treatment is necessary to prevent complications from developing. Birthmarks are treated with lasers and less often surgery
Red or vascular birthmarks
Portwine stain is a vascular malformation that must be treated early. It is present at birth, affecting 0.3% of newborns and is often seen on the head and neck. If left untreated,
- It continues to grow, becomes thicker and larger and can develop into purple papules and nodules
- It may bleed
- It is susceptible to trauma
- It gets infected
- Over time it may cause distortion of the face or the limbs
Treatment for port wine stain
- Should be started early, even in infancy when the birthmark is thin and flat and is easy to treat
- The Pulse dye laser treatment (V beam Perfecta) or 589nm ADVATx laser is the treatment of choice
- Thick port wine stain is best treated with the long pulse Nd YAG laser (Excel V).
Port wine stain
Haemangioma is a common vascular birthmark occurring in 12% of new born. It grows rapidly within the first year, faster than the rest of the body. It starts to get smaller by the end of the first year. By 5 years, 50% will have involute spontaneously. Thereafter it involutes 10% each year and clears by the time the child is 10 years old.
Although haemangioma resolves on its own, 40-50% of them may leave a scar. Treatment is needed if
- The haemangioma compromise body function like blocking the airway, the eyes, the mouth, the ear or the ano-genital region.
- Complications are present like ulceration, bleeding and infection
- It is rapidly growing
- It is a large haemangioma as this is likely to leave scar after involution
Treatment of haemangioma depends on the size and location and includes
- Topical creams
- Oral medication
- Pulse dye laser / ADVATx laser / Excel V laser
Salmon patch is a pink and flat birthmark that is seen in 25-40% of newborn. It can be seen anywhere in the body as stock bites ( salmon patch on the nape of the neck) or angel’s kisses (salmon patch on the forehead, eyelid, nose and upper lip).
Treatment of salmon patch
- No treatment as it usually resolves on its own by the time the child is 3 years
- If it persists it can be treated with the vascular laser
Brown or pigmented birthmarks
Lentigenes are small brown spots that look like freckles. They are seen in a child or an adult. Lentigenes can occur alone or in association with other medical problems. They are different from freckles in that they do not darken on sun-exposure and they do not go away by themselves.
Treatment of lentigines
- No treatment is needed
- If needed treatment is with the Picoway laser or the intense pulse light treatment
Cafe-au-liat macule CALM (”coffee with milk” in French) is a brown birthmark that can occur alone (usually benign) or can be multiple (may be associated with other medical problems). CALM is commonly seen on the face and body.
Treatment of CALM
- Treatment with the Picoway Laser or the Fraxel laser.
Naevus of Ota is a dark brown or bluish black birthmark commonly seen in Asians. It first appears at birth, or in early childhood or in the early teens. When it occurs in Asians, it is usually harmless. It is very rarely seen in Caucasians and when it occurs, it may be associated with birthmarks in the brain tissues. The white part of the eye may be involved in a third of patient.
Treatment of Neavus of Ota
- Picolaser treatment must be started early
- No treatment for Neavus of Ota in the eye
Naevus spilus (speckled lentigeneous naevus)
Naevus Spilus is a birthmark of a cafe au-liat macule (CALM) patch with multiple small moles scattered on the surface
Treatment of naevus spilus
- With a combination of lasers including the CO2 laser and picoway laser
- If small it can be excised surgically.
Becker’s naevus usually appears as a brown patch during the teenage years. Sometimes the skin is rough and hairs may be seen growing on it. It is often found on the shoulders and back. It is a harmless birthmark and is difficult to remove completely.
Treatment of becker’s naevus
- A combination of lasers like the Picoway laser or the Fraxel laser to remove the brown marks
- Hair removal laser to remove the hairs