Birthmarks

Birthmarks get their name from the simple reason that they are present on the skin of newborn babies. Many of these alterations are not important, others appear weeks after birth and others must be controlled by the doctor. Whatever the size or color of the stain and, even if it seems harmless, parents should always consult their pediatrician.

WHAT YOU SHOULD KNOW

• 80% of babies have one.
• It should be consulted with the pediatrician, even if it seems harmless, to assess it.
• They can be vascular spots, which can be treated, or pigmented, which are not treated.

Of unknown origin

About 80% of babies have some kind of birthmark. Some of these spots last a lifetime and others disappear over time. Birthmarks cannot be prevented and are not caused by something the mother did or ate during pregnancy. This is mere superstition. The origin of most birthmarks is unknown, although in some cases, they can be inherited. Freckles are not considered birthmarks, they appear years later and in the areas most exposed to the sun.

Types of birthmarks

There are two main types of birthmarks: vascular and pigmented. They are differentiated by their cause or origin. Vascular birthmarks (formed by blood vessels) are the most common and occur when the blood vessels do not form correctly: either there are too many or they are wider than normal. Pigmented birthmarks are caused by the overgrowth of cells that make pigments in the skin. Vascular stains

• Nevus flammeus neonatorum or: are smooth, pink macules that are often seen on the forehead or eyelids, the back of the neck or on the nose, upper lip, or the back of the head. They may be more obvious when the baby cries. Those that appear between the eyebrows are popularly called "angel kisses" and those in the area of ​​the neck, "stork peck". They are the most common type of vascular birthmarks, appearing in 40-71% of babies. They occur because some blood vessels of the fetus have remained superficial and do not mature and deepen into the skin. They generally disappear on their own when the child reaches one or two years of age, although some can last until adulthood. No treatment is necessary, only, in cases where aesthetic improvement is sought, the laser can be used.
• Hemangiomas: This term describes a variety of abnormal blood vessel formations. These rough, raised lesions can be large and unsightly, or they can be small and inconspicuous, affecting about 10% of babies. Hemangiomas occur mostly on the head and neck, and unlike other birthmarks, they can grow rapidly. They generally appear during the first six weeks of life (only 30% are visible at birth), and grow throughout the first year. Then, without any treatment, some tend to stop growing, turn white, and begin to regress. This reverse process can take three to ten years. 20% of children with hemangiomas have more than one, and they are more common in girls, premature babies, and twins. They should be monitored by the dermatologist to assess that there is no associated internal alteration and to plan the treatment with surgery or laser, if necessary.
• Strawberry hemangioma: it owes its name to the fruit, since its appearance is very similar. It appears in 2-5% of babies. These hemangiomas are bright red and protrude from the skin. Some disappear on their own when the child is about 5 years old. Almost all strawberry hemangiomas disappear without treatment by around 9 years of age.
• Cavernous hemangioma: cavernous means "like a cave or a grotto"; A grotto is a cavity that penetrates the ground, like this type of birthmark, which is found deeper than the most superficial layer of the skin. This type of birthmark stands out more than the strawberry hemangioma. It is also another color: not a bright red, like a strawberry, but a more bluish red. Cavernous hemangiomas do not usually go away on their own and may need specific treatment.
• Nevus flammeus, Flat angioma or Port wine stain: it is a reddish stain, less evident at birth and with a unilateral appearance (on one side of the face or forehead) although it can be found anywhere else on the body: neck, scalp, arms or legs. They can be of any size, and usually grow in proportion to the child. Many times they change in texture over time, appearing small bumps. Over the years the intensity of its color increases, becoming redder. About 0.3 percent of babies are born with these kinds of marks In most children, port wine stains are not a problem, but in other cases they can be associated with a large number of complex syndromes that they must be discarded by the pediatrician. For example, nevi flammeus located around the eye can be related to the development of glaucoma, seizures and developmental delay, which is known as Sturge-Weber syndrome.

Pigmented spots

• Nevi or congenital moles: are groups of pigmented skin cells. About 1% of babies have them. The color is brown of variable intensity and may or may not have relief. Its size is variable and can be small or involve an entire body area such as a complete limb or a large part of the trunk. Sometimes they have hairs and, although they are generally benign, they can have a variable malignant potential, therefore, it is most advisable that they be controlled by the dermatologist from birth.
• Café-au-lait spots: These are smooth tan or light brown spots, and sometimes many appear at once. Between 20 and 50% of newborn babies have one or two of these pigmented spots. They usually get smaller as the child grows, although they can also darken with sun exposure. One alone is not a problem, but it is advisable to carry out a study of the baby if he has 6 or more café-au-lait spots, as this may be a sign of neurofibromatosis (a genetic disorder that causes abnormal growth of cells in nerve tissues) .
• Achromic nevus: it is a mole or white spot. It means that the melanocytes, which are responsible for giving the skin its color, are present in less quantity. They can develop anywhere in the body and their importance lies in the fact that they can be related to some disease at the level of the nervous system, such as neurofibromatosis and tuberous sclerosis.
• Nevus of Ota: it is located especially in the facial region and can involve the eye. It tends to increase in size and is brown or slate gray in color. It is a static stain and does not disappear unless laser is applied. It is not harmful, not even when it involves the ocular region, but it has an important aesthetic implication.
• : is a bluish, greenish or gray pigmentation alteration that covers large areas on the baby's back and buttocks. It has no relief and usually disappears at 2-5 years spontaneously. In some cases, it can be permanent. They are more common in dark-skinned babies. They are not related to any disease or cause any discomfort to the baby, so they are not treated or need to do any special monitoring.

Treatment

The treatment applied is different depending on the type of stains to be treated. Treatment of vascular stains Vascular birthmarks can be treated. The exception is macules, which generally disappear on their own. Those on the back of the neck may be more persistent, although they are not very obvious. Flat hemangiomas and certain hemangiomas can be disfiguring and complex in children. In general, hemangiomas do not need treatment, since they shrink until they disappear when the child reaches 9 years of age. Larger or more severe hemangiomas are often treated with steroids, surgery, or lasers. Laser is the most common treatment for flat hemangiomas. Most fade significantly after several laser treatments, although some reappear and must be treated again. Laser treatment is often started in childhood, when the spot and blood vessels are smaller. The marks found on the head and neck respond best to laser treatment. Flat hemangiomas can also be camouflaged with special opaque makeup in adulthood. Treatment of pigmented spots

In general, pigmented birthmarks are not treated, except for moles and sometimes café-au-lait spots. Moles (especially large or giant congenital nevi) are sometimes removed by surgery, although larger ones can be more difficult to remove. Café-au-lait spots can be removed with lasers, but they often reappear.