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Birthmark Basics When my niece was born several weeks ago, cute and adorable as she was, all I seemed to focus on were the pale pink patches in the middle of her forehead and under her nose. She had a beautiful crop of thick black hair, something unique to the thin tresses my sisters and I have, and soft blue eyes, but oh my God, she had a birthmark. Truth is, in our terribly appearance-conscious society, birthmarks have severe stigmas, and my first thought was: will it go away? My reaction wasn't unique, according to Dr. Richard Antaya, associate professor of dermatology and pediatrics and director of pediatric dermatology at Yale-New Haven Hospital in New Haven, Conn. "Most parents are really upset about a birthmark," he said, "they're expecting a perfect baby." Not a lot is known about birthmarks, which often makes them mysterious to people. "Psychosocially it's damaging for parents," he added. "People often don't think before they speak, and will gasp when they look at a new baby and say, 'oh, what happened to him?' " But while parents should be concerned about red birthmarks, in most cases they're nothing to worry about and will fade. Birthmarks are the result of an abnormal fetal development of blood vessels, and come in many shapes and sizes; the two major types are hemangiomas and port wine stains. Hemangiomas are red vascular birthmarks, commonly called strawberry marks, that may be flat or raised. "They're really tumors of immature blood vessels," said Dr. Antaya, and they may either grow or remain the same size. They're the result of too many blood vessels in one spot. A port wine stain is an abnormal collection of dilated blood vessels which gives the skin a red appearance. With a port wine stain, the number of vessels are normal, but they're dilated. Statistics show that 1-in-10 children are born with a birthmark, and 1-in-100 will require medical treatment. Most birthmarks are harmless vascular marks, otherwise known as "stork bites" and "angel kisses" that will fade as the child grows. About 50 percent
of birthmarks will fade by time a child turns 5, 70 percent by age 7,
and 90 percent by age 9, according to "With the majority of them, we usually say wait and see; let nature take its course," said Dr. Antaya. The trouble with birthmarks is that no one knows why they occur, and to further complicate things, not a lot of doctors fully understand and treat birthmarks. "The problem is that this area of medicine doesn't fall under any particular discipline," said Linda Shannon, founder and executive director of the Vascular Birthmarks Foundation in Albany, N.Y. "No one has taken ownership of it and you've got pediatricians, dermatologists and surgeons treating it. The medical literature hasnšt been updated in 100 years." When Shannon's daughter was born with a hemangioma, she wasn't satisfied with her pediatrician's advice to wait and see if it resolved itself. She began doing her own research, eventually taking her to Dr. Milton Waner of the Arkansas Children's Hospital, a leading U.S. specialist in diagnosing and treating birthmarks. Today, Shannon is the author of a book, "Birthmarks: A Guide to Hemangiomas and Vascular Formations," and runs the Foundation with Dr. Waner as its medical director. She advises parents to be sure that any mark is properly diagnosed. While most don't require treatment, complications can occur in some cases, especially if a hemangioma is near the nose and affects breathing. If a port wine stain is over an eye, it can be associated with glaucoma or other problems. Dr. Antaya agrees that proper diagnosis is key. "The problem with a lot of these marks is that we have so many names for them. The nomenclature has plagued medicine." You'll often hear doctors refer to birthmarks as port wine stains, hemangiomas, stork bites, angel kisses, salmon patches, strawberry marks and midline venular malformations, according to Shannon, but they're all different and need to be looked at differently. "Go to a doctor who knows and understands birthmarks," she said. "You can go to 10 pediatricians and only one will know about them." The type of hemangioma that Shannon's daughter had required surgery. Shannon was certain that the collection of blood vessels would most probably resolve itself, or involute, but she was concerned that it would leave a disforming excess skin. "Every other doctor told me it would take three to five operations to have her look normal," said Shannon. "Dr. Waner told me he could have her looking normal in one three-hour procedure." And he was right, today her six-year-old doesn't have one sign of her hemangioma. Good surgeons are hard to find, according to Dr Antaya. "You need a special surgeon; someone who is very good at it." Other birthmarks,
like port wine stains, are often treated with lasers as the child gets
older, according to Dr. Antaya. Other serious marks may require therapy
with steriods, or in extreme emergencies, with Interferon. "There's a lot of new technology out there," he added. "A lot of research is going into this, especially on how to stop blood vessel growth. Within time, we'll have even better treatments." Shannon also predicts that with time, doctors will understand why birthmarks occur. "There's one common denominator," she said, "infection during pregnancy, like a sinus or urinary tract infection, or something like that." New research, she said, is focusing on the placenta. "If something disrupts the placenta, it can disrupt the fetus. But it's hard to test and prove."
How to Recognize a Birthmark Hemangiomas: Red vascular birthmarks which may first appear as a small dot in the first few weeks after birth. Some may stay small and flat, while others may grow rapidly. Most hemangiomas grow rapidly during the first year and regress or involute after that. Most will regress by 5-7 years old. Some grow so fast that they require steriod treatments. Can cause complications if the hemangioma is near the eyes, nose or mouth. Vascular malformations: Benign vascular lesions that are always present at birth. Unlike hemangiomas, they grow slowly and steadily throughout life and often don't regress. Midline venular malformations or macular stains: Fade in color during the first year of life. Also called stork bites and angel kisses. Stork bites appear in the nape of the neck; angel kisses occur on the forehead and brow area and between the eyes and upper lip. Port wine stain: A pink to purple mark composed of an abnormal collection of dilated blood vessels. The skin looks as if port wine has been poured on it. Most are present at birth and appear to grow at the same rate as surrounding tissues. They often appear as flat pink stains throughout the first two decades of life. They can be smooth at first, and develop a cobblestone appearance by a person's 40s, 50s or 60s. Resources to help you There are several good places on the web for birthmark information. • The Vascular
Birthmarks Foundation – www.birthmark.org
Books: "Birthmarks: A Guide to Hemangiomas and Vascular Formations," by Linda Shannon |