Birthmarks
Contrary to the name, birthmarks do not always appear at birth. Most birthmarks are permanent, but there are several types of birthmarks that fade as a child grows. Birthmarks can be flat or raised, have regular or irregular borders, and have different shades of coloring. The two main types of birthmarks are red, vascular birthmarks, such as hemangiomas and port wine stains, and pigmented birthmarks, such as moles, café-au-lait spots, and Mongolian spots.
Birthmarks are most commonly harmless; however, in some cases birthmarks are associated with other health problems. It is important to find out if this is the case for you or your child. At Dermatology Associates of Wisconsin, we offer pediatric dermatology services and specialize in the care and treatment of skin, hair, and nail problems that affect infants and small children.
Port wine stain
Port wine stains are birthmarks composed of dilated small blood vessels in the skin that occur in 1 in 200 newborns. They are most often located on the face, neck, arms or legs but can occur anywhere on the body. These lesions present at birth as pink patches. Over time, portwine stains become darker red to purple in color and may thicken. Port wine stains do not go away, but treatment is available to dramatically improve the appearance of the stain and prevent darkening and thickening of the birthmark.
For most children, port wine stains are not associated with any other health concerns. Port wine stains of the face, however, can occasionally be associated with eye problems (glaucoma) and neurologic problems such as seizures (Sturge-Weber syndrome). Similarly, large port wine stains of the arms or legs can be associated with enlargement of the affected extremity. As a result, it is important to be evaluated early by a pediatric dermatologist to determine if treatment is needed.
Treatment Options (not limited to):
+Pulsed Dye Laser
Pulsed dye laser treatment is safe and effective in treating infants and young children. The pulsed dye laser emits a burst of light that is absorbed by the small blood vessels directly beneath the surface of the skin. Laser therapy works best during infancy and early childhood when the skin has not reached its maximum thickness, thereby, allowing the laser to reach the small blood vessels.
Laser therapy involves repeated treatment of the stain at 6 to 8 week intervals for an average of 6 to 8 treatments. Most children demonstrate significant improvement. While laser therapy usually fades port wine stains and decreases the risk of skin thickening, it is rare for laser treatment to completely remove the stain. Nevertheless, the treatment outcome for children with port wine stains is outstanding, bringing relief to parents and changing the lives of affected children.
Hemangioma
Hemangiomas are birthmarks composed of extra blood vessels. They are one of the most common skin conditions in the first year of life affecting up to 10% of infants. Hemangiomas may be present at birth, but more frequently appear during the first month of life. Hemangiomas have different appearances, depending upon the depth of the blood vessels.
Superficial hemangiomas tend to be bright red and elevated from the surface of the skin. Deeper hemangiomas are blue in color. Most hemangiomas are found on the head or neck, although they can be found anywhere on the body. Hemangiomas grow for the first 6 to 8 months of life, and then stabilize in size for several months before gradually resolving. Approximately 50% of hemangiomas resolve by 5 years of age and 90% by 9 years of age.
Treatment of hemangionmas is not always necessary, however, hemangiomas that cause skin breakdown, disfigurement, and interfere with feeding, sight, breathing, and other vital functions require treatment. There are some other rare situations that also require immediate intervention. It is very important that a child be seen early by a pediatric dermatologist to minimize complications in cases where the hemangioma bleeds, forms a sore or bruise, appears infected, involves the nose, lips, eyelids, ears or diaper area, or grows suddenly over a matter of days.
Treatment Options (not limited to):
+Active Observation
Although, most hemangiomas do not require therapy, it is very important that all hemangiomas be monitored closely. This is especially true during the first few months of life when hemangiomas grow the fastest. Complications including skin breakdown and bleeding need to be addressed quickly in attempts to minimize pain and permanent scarring.
+Beta-Blockers
Beta-blockers, specifically propranolol (oral), have been shown to be effective treatment options for hemangiomas. The exact mechanism of action is unknown. Oral propranolol is now considered the treatment of choice for hemangiomas requiring treatment. Oral propranolol has been used for many years to treat high blood pressure in children and adults. Several years ago, it was noticed to greatly improve the outcomes for hemangiomas.
Unlike steroids, beta-blockers not only prevent additional growth of the hemangioma, but shrink the existing hemangioma. They have also been used successfully for hemangiomas beyond the growth phase. Oral propranolol is well tolerated when used appropriately. Close follow up and cardiac evaluation prior to dose adjustments, however, is necessary given the risk of lowering heart rate and blood pressure. The medication is given by mouth two to three times a day. It is important that the medication be given after feeds as it can cause a drop in blood sugar if the infant has not eaten. Treatment is usually continued for 6 to 12 months, however, is highly dependant on the location and growth characteristics of the hemangioma.
Timolol is a beta-blocker that is applied topically to the surface of hemangiomas twice daily. It has been shown to be effective in treating very superficial hemangiomas.
+Corticosteroids
Oral corticosteroids were the mainstay in treatment of hemangiomas prior to the use of beta-blockers. Unlike beta-blockers, they are only used during the growth phase and usually do not shrink the existing hemangioma but slow further growth. Potential side effects include irritability, restlessness, suppression of the immune system, elevation of blood pressure, weight gain, and gastrointestinal upset. Most treated infants, however, do very well. Treatment is usually continued for weeks to months, however, is highly dependant on the location and growth characteristics of the hemangioma.
Corticosteroids can also be injected into the hemangioma. This treatment is most effective for small, localized hemangiomas.
+Pulsed Dye Laser
The pulsed dye laser treatment is safe and effective in treating infants and young children. The pulsed dye laser emits burst of light that is absorbed by the blood vessels beneath the surface. This causes them to warm and coagulate and the body absorbs them during the natural healing process. Pulsed dye laser is used for ulcerated hemangiomas to reduce pain and lead to quicker healing. Pulsed dye laser is also used to treat telangiectasias (residual small broken blood vessels) on the surface of the skin that may be present after a hemangioma has resolved.
+Surgery
Surgical excision is usually reserved for cases in which fibrofatty tissue or scarring remains after the hemangioma has resolved or for hemangiomas that are shrinking very slowly and have not resolved by the time the child is about to enter school. Excision is also reasonable in cases where pharmacological therapy is not effective or well tolerated and the hemangioma threatens life or bodily function.
Congenital Moles (Congenital Nevi)
Congenital moles are defined as moles that are present at or shortly after birth. They are classified by size: small, medium, large, or giant. Small congenital moles are present in approximately 1 percent of all newborns, whereas giant congenital moles are much less common with an incidence of 1 in 20,000 newborns.
Congenital moles are important due to their increased lifetime risk of developing into a type of skin cancer known as malignant melanoma. The exact risk of a small or medium-sized congenital mole changing into a melanoma is controversial with an estimated lifetime risk less than 3 to 5%. The risk of developing a melanoma in a small or medium congenital mole is greatest after puberty. As a result, removal can be delayed until the child is older, however, the mole will grow as the child grows thereby resulting in a larger scar.
It is important to inspect congenital moles on a regular basis at home. We often recommend that a dermatologist observe small and medium congenital moles once a year and larger congenital moles more frequently. Some early warning signs of malignant melanoma include asymmetry (one half of the mole does not match the other); an irregular border (ragged or blurred edges); multiple shades or colors within a mole (such as varying shades of brown, black, red, white, or blue); or a mole that is larger than a pencil eraser in size.
Click here for more information on Skin Cancer.
Treatment Options (not limited to):
+Surgical Excision
Most moles do not require treatment. A dermatologist will remove a mole that bothers a patient, a patient finds unattractive, or if the mole could be skin cancer. The dermatologist cuts out the entire mole and stitches the skin closed. If the dermatologist suspects that the mole contains cancer, the dermatologist will send the mole to be further examined under a microscope. This is called a biopsy.
+Shave Removal
A shave removal or shave biopsy is a method of removing a mole that is commonly performed when the mole lies above the surface of the skin. This method is one of the more preferred methods by both patients and dermatologists, especially when it is done for aesthetic purposes. The entirety of the mole is not removed, only the part that is visible.
