| Definition: |
Reddish colored, vascular (blood vessel) skin markings that develop before or shortly after birth. (See also birthmarks, pigmented.)
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| Alternative Names: |
Strawberry hemangioma; Strawberry mark; Vascular skin changes; Angioma cavernosum; Capillary hemangioma; Hemangioma simplex
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| Causes, incidence, and risk factors: |
There are two main categories of birthmarks. Red birthmarks are a vascular type of birthmark. Pigmented birthmarks are areas in which the color of the birthmark is different from the color of the rest of the skin.
Hemangiomas are a common vascular birthmark. They are usually painless and benign. The cause of hemangioma development is unknown. The color results from a proliferation of blood vessels at the sight.
Strawberry hemangiomas (strawberry mark, nevus vascularis, capillary hemangioma, hemangioma simplex) may appear anywhere on the body, but are most common on the face, scalp, back, or chest. They consist of small, closely packed blood vessels. They may be absent at birth, and develop at several weeks. They usually grow rapidly, remain a fixed size, and then subside. 95% of strawberry hemangiomas disappear by the time the child is 9 years old, although there may be some slight discoloration or puckering of the skin where a strawberry hemangioma existed.
Cavernous hemangiomas (angioma cavernosum, cavernoma) are similar to strawberry hemangiomas but are more deeply situated. They may appear as a red-blue spongy mass of tissue filled with blood. Some of these lesions disappear on their own, usually as a child approaches school age.
A port-wine stain (nevus flammeus) is a flat hemangioma made of dilated blood capillaries. The face is the most common location. The size varies from very small to over half of the body surface. This is often a permanent defect, sometimes causing significant psychologic distress. Facial lesions may be associated with Sturge-Weber syndrome. Large lesions on the extremities can be associated with soft tissue growth and enlargement of the extremity.
Salmon patches (stork bites) are small, pink, flat spots. They are extremely common, appearing on 30 to 50% of newborns. They are small blood vessels (capillaries) that are visible through the skin. They are most common on the forehead, eyelids, upper lip, between the eyebrows, and the back of the neck. They may be more noticeable when the infant cries or during temperature changes. They often fade as the infant grows. Salmon patches on the back of the neck may not fade but are usually not noticeable as the hair grows.
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| Signs and tests: |
All birthmarks should be examined by a health care provider. Diagnosis is based primarily on the appearance of the skin lesion.
Biopsy, CT scan or MRI of the area may confirm deeper birthmarks (for example, an abdominal MRI). |
| Treatment: |
Many capillary birthmarks (strawberry hemangiomas, cavernous hemangiomas, salmon patches) are temporary and require no treatment.
Nevus flammeus type of hemangiomas may require no treatment unless they are disfiguring or psychologically distressing, or unless they develop new symptoms such as pain or change in appearance.
Permanent lesions may be disguised with cosmetics, especially cosmetics designed to be concealing or covering (such as Covermark).
Oral or injected cortisone may be used to reduce the size of a hemangioma that is growing rapidly and obstructing vision or vital structures.
Permanent birthmarks may be treated with cryotherapy (freezing), surgical removal, or laser surgery. They are usually not treated unless symptomatic, or until a child is at least school age. However, port wine stains on the face should be treated at a young age with a yellow pulsed dye laser for best results and to prevent the often profound psychosocial problems caused by the port wine stain.
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| Expectations (prognosis): |
| Birthmarks rarely cause problems other than cosmetic changes. Many birthmarks resolve spontaneously by the time a child is of school age, but some are permanent. |
| Complications: |
- psychological distress from change in cosmetic appearance
- discomfort or bleeding from vascular birthmarks (occasional)
- scarring or complications after surgical removal
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| Calling your health care provider: |
| All birthmarks should be examined by a health care provider to determine the prognosis (probable outcome), course of action, and possible complications. |
| Prevention: |
| There is no known way to prevent birthmarks. |
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