More About Hemangiomas and Birthmarks

*Continued from What You Should Think About Birthmarks.

Vascular lesions are the result of an increase in the number of blood vessels in the skin. The most common types of vascular birthmarks are salmon patches, hemangiomas and port wine stains.

Salmon Patches (nevus simplex) are the most frequently diagnosed vascular birthmark. They are flat, mild red or pink and are sometimes called “angel’s kisses” when they appear on the forehead, eyelids, nose or upper lip and “stork bites” when they are found on the back of the neck. Angel’s kisses most often go away by age 1-2, but stork bites may last into adulthood. They are typically harmless and require no treatment.

Hemangiomas are a benign growth of blood vessels, and occur in as many as one out of 10 infants. They can be divided into two types: superficial (formerly referred to as strawberry hemangiomas) and deep (formerly referred to as cavernous hemangiomas). Superficial hemangiomas are raised and bright red because the abnormal blood vessels are very close to the skin’s surface. Deep hemangiomas have a bluish-purple color because the abnormal vessels are deeper under the skin. They are most often not present at birth but slowly enlarge during the first six to nine months of life. They subsequently slowly resolve (improve in appearance) over several years. After the first year, most hemangiomas stop growing. Approximately 50 percent of hemangiomas resolve by age five, and 90 percent are flat by age nine. Texture change or superficial blood vessels may remain on the skin even after complete resolution. The most commonly utilized treatments for hemangiomas include close observation, corticosteroids, and wound care when a lesion is ulcerated. When hemangiomas grown in locations that can threated vision, damage cartilage around the nose or ear or cause significant facial deformity, it is often necessary to treat the patient with oral steroids. Pulse-dye laser treatment may also be used to treat hemangiomas after or during involution (shrinking stage), but are only helpful for superficial hemangiomas. Hemangiomas with sores that will not heal may also benefit from the treatment of lasers. Surgery is sometimes performed during or after involution if a hemangioma leaves excess skin or tissue behind. Surgical removal is rarely performed on hemangiomas when they are actively growing.

Port-wine stains (capillary malfomations) appear at birth in approximately three out of every 1,000 infants. They are flat, pink, red or purplish discolorations often found on the face, but can be present anywhere on the body. Unlike other birthmarks, port-swine stains grow proportionally as the child grows. While their texture and shade may change they are permanent without treatment. Specially designed cover-up makeup can be used to reduce the appearance of port-wine stains. Treatments can start in infancy and need to be performed several times to achieve maximum lightening.

Birthmarks, particularly facial hemangiomas, can cause significant psychological and social distress for both parents and children. It is normal for both parents to feel a variety of emotions, including panic, sadness, guilt, and disbelief. Even when you tell your parents their child’s hemangioma will eventually disappear, it is not necessarily good news to them, especially when their infant’s appearance was flawless at birth but is now growing a bright red lesion.

Dealing with reactions of strangers can also be stressful. When faced with stares or questions about their child’s birthmark, dermatologists advise parents and children to do what feels comfortable to them. For some, answering questions about the birthmark is fine, while others may choose to ignore insensitive comments altogether. Parents and older children with birthmarks who are particularly distressed may benefit from talking to other children who have birthmarks and their parents.