Birthmarks

Some individuals are born with a unique mark on their skin or have come across someone with a distinct mark on their skin, which is commonly referred to as birthmarks. For some, these marks are small, faint, and barely noticeable. However, some have a larger or more prominent mark. Birthmarks are entirely natural and generally harmless, but many individuals may find their birthmarks to be unsightly to a point where it affects their mental wellbeing.

What are birthmarks?

Birthmarks are coloured spots on the skin that are typically present at birth or develop shortly afterward. These skin markings can range in colour, size, and shape. Some birthmarks are subtle; others may be more noticeable and distinct. Although most birthmarks are harmless, understanding their characteristics can help determine if a birthmark requires closer attention from a licensed and qualified dermatologist.

What causes birthmarks?

Birthmarks are caused by an excess of cells [1] or blood vessels in the skin. They appear when certain pigments or cells cluster in specific areas, giving the skin a distinct colour or texture. There are two main types of birthmarks, which are:

• Vascular birthmarks: birthmarks that are formed due to abnormal blood vessels.
• Pigmented birthmarks: birthmarks that are formed due to an excess of pigment cells in the skin.

Although the exact causes why these clusters of cells are formed are unknown, it is widely believed that genetics [2] and certain prenatal factors do play a role.

Types of birthmarks

Vascular birthmarks are often red, pink, or purple in colour, with the following characteristics:

• Cavernous hemangiomas – cavernous hemangiomas are larger, deeper, and can have a bluish colour due to the blood vessels located beneath the skin’s surface. They are generally soft to touch and may shrink as a child grows.

• Strawberry hemangiomas – strawberry hemangiomas, or commonly known as infantile hemangiomas, are typically raised red and often have a bumpy appearance. They usually appear soon after birth and can grow rapidly in the first few months before gradually fading over time.

• Salmon patches – salmon patches, also known as stork bites or angel kisses, are flat and pink in appearance and are often located on the forehead, eyelids, or back of the neck. Similar to cavernous hemangiomas, they often fade as a child grows.

• Port-wine stain – port-wine stain birthmarks are flat and pink, red, or purple in colour. Unlike other vascular birthmarks, port-wine stains do not fade over time. They are caused by an abnormal capillary network under the skin.

Meanwhile, pigmented birthmarks are the result of excess pigment cells, giving the skin darker patches or spots, such as:

• Congenital nevi – congenital nevi are large moles present at birth and may vary in colour and size. Due to these characteristics, congenital nevi have a slightly higher risk of developing into melanoma [3].

• Dermal melanocytosis – dermal melanocytosis, also known as Mongolian spots, are blue or grey patches that are often seen in people with darker skin tones. They are usually located on the lower back or buttocks. However, they tend to fade as the child gets older.

• Pigmented nevi – pigmented nevi, or better known as moles, are brown or black in colour. They can either appear flat or raised, depending on how these abnormal clusters of cells are formed, and can develop anywhere on the body.

• Café-au-lait spots – café-au-lait spots are light brown flat spots that appear on the skin. Due to their colour, they look similar to coffee with milk, hence the name. While one or two spots are generally harmless, multiple spots may be indicative of certain genetic conditions.

When should I be worried about a birthmark?

Although most birthmarks are harmless, and pose no medical concern, some may require closer observation as they can occasionally signal underlying health issues, such as skin cancer. In fact, some of the signs that warrant medical advice from a licensed dermatologist include:

• Irregular Borders — edges that appear uneven, blurred, or asymmetrical.
  
• Colour Changes — a birthmark that darkens, becomes multi-coloured, or appears red, and inflamed.
  
• Itching or Pain — a birthmark that becomes itchy, tender, or painful to touch.
  
• Rapid Growth — a birthmark that suddenly grows in size, or changes shape.
  
• Texture Alterations — development of lumps, crusting, bleeding, or ulceration on the birthmark.

It is important to note that certain birthmarks, such as large congenital melanocytic naevi, may carry a slightly higher risk of melanoma, which is a type of skin cancer. While the risk is still relatively low, it is crucial to monitor these birthmarks regularly. Additionally, pigmented birthmarks that appear uneven in colour, or texture can sometimes mimic melanoma. Should you have any concerns, please consult a doctor for peace of mind. 

Vascular birthmarks, like port-wine stains, on the other hand, are generally non-cancerous but should still be assessed for complications, particularly if they involve sensitive areas like the eyes.

Can birthmarks be removed?

While many birthmarks are harmless and do not require treatment, some people choose to reduce or remove them due to cosmetic reasons or health concerns. The treatment options vary depending on the type, size, and location of the birthmark.

Generally, birthmarks are often treated with topical treatments or dermatological procedures.

Topical treatments for birthmarks

• Lightening creams – Certain creams may help lighten pigmented birthmarks. But these treatments are more effective for smaller or lighter-coloured spots.

• Steroid creams – Steroid creams can help reduce the size and colour of hemangiomas. However, the results may vary depending on how your skin responds to the steroid creams.

Dermatological procedures for birthmarks

• Cryotherapy – Cryotherapy is performed by freezing the birthmark with liquid nitrogen. Although it does help in reducing its size or prominence, this treatment is often used for small and raised pigmented spots.

• Laser therapy – Laser treatments, especially pulse-dye lasers, can effectively reduce or remove vascular birthmarks, such as port-wine stains and hemangiomas. It works by targeting blood vessels beneath the skin, thereby reducing redness over multiple sessions.

• Surgical removal – Larger or raised birthmarks, such as congenital nevi, may be surgically removed if there are health risks or for aesthetic reasons.

Summary

Most birthmarks are typically present at birth or appear shortly afterward and are not influenced by lifestyle or environmental factors.

However, it is important to note that monitoring your birthmarks and protecting your skin from excessive sun exposure can help reduce the risk of complications. In fact, if you notice any changes in your birthmarks, it is highly encouraged to have them examined by a licensed and qualified dermatologist.

At Livingstone Dermatology, we strive to offer top-quality services while prioritising our clients’ comfort. Get in touch with us today to schedule an appointment and have access to a personalised treatment plan to achieve your hair and skin goals.

Frequently Asked Questions

How common are birthmarks?

Birthmarks are quite common, with approximately 1 in 10 babies born with some type of birthmark.

Is it possible to develop birthmarks as you age?

Yes, it is possible. While true birthmarks are present from birth, similar spots, such as moles or other pigmented marks, can develop later in life. This is especially true if you are frequently exposed to excessive UV rays.

Are there any complications associated with birthmarks?

Most birthmarks are harmless. However, larger or atypical birthmarks may carry a small risk of complications, such as ulceration or bleeding, especially if they are located in high-friction areas.

What is the likelihood of birthmarks becoming cancerous?

The risk of birthmarks becoming cancerous is generally low. Be that as it may, congenital nevi and certain large, pigmented birthmarks may have a slightly higher chance of becoming cancerous. In such instances, routine monitoring by a dermatologist is often recommended to guarantee timely intervention and a more positive post-treatment outcome.

Are there any potential side effects associated with birthmark removal treatments?

Side effects can vary depending on the treatment option. While these side effects range from mild redness to swelling to scarring, it is highly rare. During a pre-treatment consultation, our dermatologist will inform you of any potential side effects and expected outcomes to ensure you are well informed.

How can I differentiate birthmarks from keloid scars or regular moles?

Birthmarks are often present at or shortly after birth. On the other hand, keloid scats are raised bumps that are formed after skin injury, while moles are dark spots that can appear at any age.

If you are uncertain about the beauty marks on your skin or would like to have it thoroughly examined, then we strongly encourage you to book a consultation with our dermatologist.

What are some of the symptoms that require a visit to the dermatologist?

Some of the symptoms that you should pay attention to include:

• Bleeding
• Changes in appearance such as colour, size, and shape
• Itching
• Pain

References

1. Felman, A. (2019). Birthmarks: Causes, types, and treatments. In www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/174886

2. Mahajan, P., Bergstrom, K. L., Phung, T. L., & Metry, D. W. (2022). The genetics of vascular birthmarks. In Clinics in Dermatology (Vol. 40, Issue 4, pp. 313–321). Elsevier BV. https://doi.org/10.1016/j.clindermatol.2022.02.006

3. Belysheva, T. S., Vishnevskaya, Y. V., Nasedkina, T. V., Emelyanova, M. A., Abramov, I. S., Orlova, K. V., Lubchenko, L. N., Utyashev, I. A., Doroshenko, M. B., Demidov, L. V., & Aliev, M. D. (2019). Melanoma arising in a Giant congenital melanocytic nevus: two case reports. In Diagnostic Pathology (Vol. 14, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s13000-019-0797-1