BIRTHMARKS

WHAT ARE BIRTHMARKS?

A birthmark is an innate, harmless alteration in the color, texture, or structure of the skin that is present at birth or may develop within a few days after birth. While some birthmarks naturally fade over time, others can persist throughout a person's life. Birthmarks can vary in:

• Shapes: They can be linear, oval, leaf-shaped, or take on various other forms.
• Size: Ranging from the size of a pinhead to covering a large area of skin or even an entire half of a body part.
• Color: They may appear red, darker, or lighter than the surrounding skin.
• Feel: Birthmarks can be flat or raised and can feel soft or firm to the touch.

Why do people have birthmark?

Birthmarks occur due to the excessive growth of structures that are normally present in the skin, such as blood vessels, melanocytes, smooth muscle, fat, fibroblasts, or keratinocytes. For instance, an overgrowth of blood vessels can result in hemangioma, while an overgrowth of melanocytes can lead to congenital melanocytic nevi.

Are birthmarks hereditary?

This is a commonly asked question by parents. While some birthmarks can be inherited across generations within a family, most are not inherited.

What are the types of birthmarks?

Commonly, birthmarks can be categorized into four types:

• Vascular birthmarks
• Hyperpigmented birthmarks
• Hypopigmented birthmarks
• Cutaneous hamartomas

What are vascular birthmarks?

Vascular birthmarks are the result of an overgrowth of blood vessels, often appearing red in color, and affect around 10-12% of children. They can be divided into three common types:

• Salmon Patch (Nevus Simplex or Transient Capillary Vascular Malformation): These light pink birthmarks are typically found on the nape of the neck, between the eyes, or on the lips (known as angel’s kiss or stork bites). They are more visible during crying and usually fade within a year without treatment.
• Hemangioma: These birthmarks, ranging from light pink to dark red or blue, are commonly found on the head, neck, and extremities. Initially appearing as flat light pink patches, they can grow into elevated soft to firm nodules. Many hemangiomas start to fade between 6 to 18 months of age (involution), with the majority becoming insignificant by age 10. Some may require medical treatment if rapidly growing or causing complications.
• Port-Wine Stains (Nevus Flammeus): These flat, light pink patches gradually become red to dark red, often thickening and forming nodules. They do not fade with time, especially those near the eyelids which may require monitoring for associated brain issues.

What are pigmented birthmarks?

Pigmented birthmarks result from an overgrowth, hyperactivity, and abnormal location of melanocytes. They are generally harmless and include:

• Café-au-lait Spots: These flat brown patches can be found anywhere on the body and are generally harmless, but multiple or larger ones may indicate a need for medical evaluation, particularly for genetic conditions like neurofibromatosis.
• Mongolian Spots: Common in dark-skinned populations, these bluish-gray patches on the buttocks or lower back typically fade by school age.
• Moles (Melanocytic Nevi): These benign collections of melanocyte cells can be present at birth or develop later, appearing brown or black with or without hair growth. Larger nevi may need monitoring for potential skin cancer development

What are hypopigmented birthmarks?

Nevus depigmentosus, also known as nevus achromicus, appears at birth or within the first year of life and typically remains stable in size. It can be mistaken for segmental vitiligo but can be differentiated by a dermatologist through clinical examination and Wood's lamp examination. This birthmark may manifest as a single white spot (focal), a white spot in a segment of the body (segmental), or in a systematized pattern covering half or whole sides of the body in lines and whorls. While generally harmless, extensive skin involvement may warrant investigation for musculoskeletal or neurological issues.

Nevus anemicus, a birthmark caused by blood vessel hypersensitivity to catecholamines, appears as an irregularly shaped pale white lesion, often found on the trunk and sometimes referred to as a pharmacological nevus. Unlike nevus depigmentosus, rubbing the skin of this birthmark does not result in red coloring due to the lack of vasodilation response.

What are cutaneous hamartomas?

A hamartoma is a tumor-like tissue malformation characterized by an abnormal overgrowth of tissue or cells typically found in the organ it affects. In the context of the skin, this is referred to as a cutaneous hamartoma and can appear at birth or later in childhood. It may originate from various skin cell types such as epidermal cells, dermal fibroblast cells, sebaceous glands, pilar muscles, or fat cells. Common types of cutaneous hamartomas include epidermal nevi, Becker’s nevus, nevus sebaceous, and nevus lipomatosus. Smooth muscle hamartomas or connective tissue nevi are rarer forms of cutaneous hamartomas.

What is epidermal nevi?

Epidermal nevi are benign growths of epidermal cells that are either present at birth or develop during the first decade of life. A common example of this type of nevi is verrucous epidermal nevi, which appear as raised, linear or whorled formations, often brown in color. These nevi typically originate on the face or neck region and gradually expand in a linear pattern following the natural lines of the skin.

What is nevus sebaceous?

Congenital melanocytic nevi are present at birth and typically found on the face or scalp. They appear as skin-colored to yellowish flat patches that thicken over time, often lacking hair growth in the affected area. Larger or rapidly growing nevi should undergo biopsy to rule out any potential cancerous changes.

What is becker’s nevus?

Becker’s nevus is a frequently benign form of cutaneous hamartoma containing epidermal and dermal components. While it often becomes visible during puberty, there are rare instances of it being present at birth. This condition is more prevalent in males. It typically appears as a light brown to dark brown patch, commonly found on the shoulders or trunk, though other areas may also be affected. Over time, it may enlarge, and approximately 50% of cases develop terminal hair growth. In rare instances, it may be linked to muscular abnormalities.

What is nevus lipomatosus?

A rare benign cutaneous hamartoma involves the abnormal presence of mature fat cells in dermal tissue, occupying around 10 to 50% of the dermis. This condition presents as skin-colored nodules that are soft to firm in texture, typically found as overgrowths on the lower back, buttocks, or shoulders. It's important for dermatologists to examine children to rule out any systemic involvement.

Which Birthmarks do Need Treatment?

• Large or prominent birthmark
• Port-wine stain birthmark
• Infantile hemangioma birthmark