Birthmarks appear in infants at birth or shortly after. Most will continue to grow as the child grows. While most are harmless, there are some that require treatment and treatment must be started as early as possible, even in the first weeks of life
Portwine stain is a vascular malformation that must be treated early. It is present at birth, affecting 0.3% of new born 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 of 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 ADVATx is the treatment of choice
- Thick port wine stain is best treated with the long pulse Nd-YAG laser (Excel V).
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 compromises 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 a scar after involution
Treatment of haemangioma
- Depends on the size and location
- Topical creams
- Oral medication
- Pulse dye laser / Excel V laser
Salmon patch is a pink and flat birthmark that is seen in 25-40% of new born. It can be present 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). It usually resolves on its own by the time the child is 3 years old.
Treatment of salmon patch
- Treatment is not necessary
- If it persists it can be treated with the Pulse dye 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 must be started early with the Picoway laser.
Cafe-au-liat macule CALM (”coffee with milk” in French) is a brown birthmark seen in 10% of the population. It can occur at birth or within the first 5 years. CALM is commonly seen on the face and body. It is usually harmless and does not require treatment. However, if there are many spots it might be associated with other medical problems. If the baby has 6 spots or more with freckles in the axilla or groin see a dermatologist to exclude neurofibromatosis
Treatment of CALM
- Usually no treatment is required
- If required laser treatment with either Picoway or the Fraxel laser.
Mongolian spots are flat, grey-blue colour (almost like a bruise) commonly seen in newborn. They can be small or large and seen usually on the back or buttocks. Mongolian spots are harmless and usually fade away by the time the child goes to school.
Treatment of Mongolian spots
- No treatment
- If it persists beyond childhood, it can be treated with the Picoway laser