birthmark

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Birthmark persistent, visible marks on the surface of the body, present from the time of birth, usually a naevus: a local overgrowth of blood vessels, or haemangioma.

From ancient times, birthmarks have traditionally been seen as a consequence of a mother's fears, fantasies, or unfulfilled cravings, and this idea acquired a certain doctrinal character during the Enlightenment. Before the eighteenth century the association of maternal passions and emotions with skin blemishes, with certain forms of bodily deformities, and, ultimately, with ‘monsters’ was based on little more than numerous testimonials and anecdotes. Both Aristotle and Hippocrates had cited the maternal imagination to account for birthmarks and abnormalities. It was also in that vein of pathological explanation that the theory survived during the Middle Ages and the Renaissance. Though it was provisionally abandoned by the scientific élite of the seventeenth century, discussion on whether there was any form of correlation between maternal emotions and fetal conformation continued during the eighteenth century and in Romanticism, in popular culture, in folklore, and, to a lesser extent, in scientific and pseudoscientific literature.

Prior to the first important systematization of the powers of maternal imagination, by the French theologian and philosoper Malebranche in the late seventeenth century, stories about the effects of the mother's thoughts upon the fetus had been on the increase, mainly in compendia and treatises of natural history. These sources show, however, considerable variation in the basic principles: similar causes, the fears and cravings of the mother, did not produce the same effects in all cases, and for the most part, they did not produce any effect whatsoever. On the other hand, even the most fervent upholder of the powers of the imagination on the fetus was willing to call into question the veracity of many of the stories compiled within scholarly or popular traditions. Beginning with the book of Genesis, where Jacob is said to have produced spotted cattle by presenting the animals with lined rods, the alleged powers of the mother's imagination resulted in the most extraordinary fabrications. The French historian Paradin, for example, wrote about the niece of Pope Nicholas III, who gave birth to a child covered with hair, and with bear claws instead of fingers. Another was born with his tripes hanging from his belly because the slaughter of a sheep was contemplated by the mother. And the Dutch scholar Schenkius informs us that a woman from Louvain who conceived on the day of the Epiphany gave birth to three children of three different races.

Despite the lack of evidence traditionally associated with these stories, from 1690 to 1700, communications concerning teratology (the science that deals with fetal malformations) in the Philosophical Transactions of the Royal Society London and the Mémoires of the French Académie, Paris, frequently debated the possibility of the power of the maternal imagination. Furthermore, after the publication in 1714 of De morbis cutaneis, by the English surgeon Daniel Turner, a dispute occurred, first in England and then on the Continent, about the influence of the maternal imagination on the creation of birthmarks and other forms of major or minor abnormalities. The repercussions of this ongoing debate lasted until the late eighteenth century: even after the English surgeon John Hunter had denied the reality of the power of the mother's imagination in a thoughtful empirical study, the French physician Louis Nicolas Benjamin Bablot wrote opposing treatises on the subject. The French surgeon Jean-Baptista Demangeon did likewise at the beginning of the nineteenth century. Even in the late nineteenth century numerous articles were published in the Journal of the American Medical Association which supported the theory. The scholars Gould and Pyle in their famous book Anomalies and Curiosities of the Medicine, published in 1896, also supported the belief. And even though most teratologists today would agree that major physical malformations do not result from maternal impressions, some behavioural scientists still consider that certain prenatal events, such as maternal stress, may have an effect on fetal development.

— Javier Moscoso

See also congenital abnormalities.

Definition

Birthmarks are areas of discolored and raised spots found on the skin. Birthmarks are groups of malformed pigment cells or blood vessels.

Description

Vascular birthmarks are benign (noncancerous) skin growths comprised of rapidly growing or poorly formed blood vessels or lymph vessels. Found at birth (congenital) or developing later in life (acquired) anywhere on the body, they range from faint spots to dark swellings covering wide areas.

Birthmarks are most often found on the head or neck but can be anywhere on the body. The common appearing birthmark is a tiny red or purple mark. A specific group of birthmarks, called "strawberry spot," "portwine stain," and "stork bite," are medically called hemangiomas. These birthmarks are essentially an overgrowth of blood vessel tissue in a specific area on the body.

Many birthmarks disappear without any special treatment, but some remain the same size or enlarge. In rare cases, the strawberry mark may cover large area of the face and body.

Demographics

About one in every three infants has a birthmark. Twice as many girls as boys have birthmarks. For appearance or cosmetic reasons, medical treatment may be necessary if the birthmark does not disappear on its own. Treatment for most birthmarks is delayed until the child is older.

About 10 in every 100 babies have vascular birthmarks. Skin angiomas, also called vascular nevi (marks), are overgrown blood vessel tissue (hemangiomas) or lymph vessel tissue (lymphangiomas) beneath the skin's surface. Hemangiomas are on the face and neck (60%), trunk (25%), or the arms and legs (15%). Congenital hemangiomas, 90 percent of which appear at birth or within the first month of life, grow quickly and disappear over time. They occur in 1–10 percent of full-term infants, and 25 percent of premature infants. About 65 percent are capillary hemangiomas (strawberry marks), 15 percent are cavernous (deep) hemangiomas, and the rest are mixtures.

Vascular malformations are poorly formed blood or lymph vessels that appear at birth. One type, the salmon patch (nevus simplex), is a pink mark comprised of dilated capillaries (also called a stork bite). It appears on the back of the neck in 40 percent of newborns and on the forehead and eyelids (also called an angel's kiss) in 20 percent. Stork bites appear in 70 percent of white and 60 percent of black newborns.

Fewer than 1 percent of newborns have port-wine stains (nevus flammeus), birthmarks. These vascular malformations of dilated capillaries appear in the upper and lower layers of the skin on the face, neck, arms, and legs. Nevus flammeus are often permanent; these flat pink to red marks develop into dark purple bumpy areas in later life; 85 percent appear on only one side of the body.

Causes and Symptoms

As of 2004 there were no known causes for congenital skin angiomas or birthmarks. Most birthmarks do not hurt; most do not cause any health problems and do not need treatment. Birthmarks may be an inherited weakness of vessel walls.

The birthmark is discoloration of the skin that starts before or just after birth. These marks can appear to be a red rash or lesion. Birthmarks tend to be different color from the skin. They are mostly flat, but some are raised, bumpy, and hairy. Many birthmarks fade or disappear altogether during the preschool years, but some never disappear completely.

Diagnosis

Patients are treated by pediatricians, dermatologists (skin disease specialists), plastic surgeons (doctors who specialize in correcting abnormalities of the appearance), and ophthalmologists (eye disease specialists), depending on the type and severity of the birthmark.

Angiomas and vascular malformations are not difficult to diagnose. The doctor takes a medical history and performs a physical examination, including visual inspection and palpation (feeling with the hands) of the marks. The skin is examined for discoloration, scarring, bleeding, infection, or ulceration. The type, location, size, number, and severity of the marks are recorded. The doctor may empty the mark of blood by gentle pressure. Biopsies or specialized x rays or scans of the abnormal vessels and their surrounding areas may confirm the diagnosis. Patients with port-wine stains near the eye may need skull x rays, computed tomography scans, and vision and central nervous system tests. Most insurance plans pay for diagnosis and treatment of these conditions.

Types of Birthmarks

There are many types of birthmarks. Certain types of raised or flat red, pink, or bluish birthmarks need close watching by a qualified medical expert as the child grows. Description of common variations in skin color and birthmarks is as follows:

• Port-wine stains: These flat, pink, red, or purple colored birthmarks are caused by a concentration of dilated tiny blood vessels call capillaries. The stains usually occur on the head, face, and neck. They may be small, or they may cover large areas of the child's body. Port-wine stains do not change color when gently pressed and do not disappear over time. They may become darker and may bleed when the child is older or as an adult. Skin-colored cosmetics will cover small port-wine stains. The most effective way of treating port-wine stains is with a special laser when the child is older.
• Stork bites or salmon patches (called angel kisses when occurring on forehead or eyelids): These small pink or red patches are often found on the baby's eyelids or forehead, between the eyes, on the upper lip, and back of the neck. The name comes from the marks on the back of the neck where, as the myth goes, a stork may have picked up the baby. This concentration of immature blood vessels is most visible when the baby is crying. Most of these fade and disappear.
• Strawberry hemangiomas: These bright or dark red, raised or swollen, bumpy areas look like a strawberry. Hemangiomas are a concentration of tiny, immature blood vessels. Most of these occur on the head. They may not appear at birth but often develop in the first two months. Strawberry hemangiomas are more common in premature babies and in girls. These birthmarks often grow in size for several months (they stop growing around the first birthday), then the birthmarks gradually begin to fade. By age five, the birthmarks fade in half the children affected, and they disappear by age nine.
• Mongolian spots: These blue or purple-colored splotches on the baby's lower back or buttocks occur on over 80 percent of African-American, Asian, and Indian babies. They also occur in dark-skinned babies of all races. The spots, a concentration of pigmented cells, usually disappear in the first four years of life.

Treatment

Treatment choices for skin angiomas and vascular malformations depend on their type, location, severity, and degree of disfigurement.

Watchful Waiting

Birthmarks are regularly examined until they disappear or require treatment. This approach is appropriate for most hemangiomas, since many eventually shrink by themselves.

Complications

When birthmarks (hemangiomas) form in an area that can interfere with the baby's normal development (for example, blocking vision or causing difficulty breathing or hearing), treatment may be necessary. If the mark begins bleeding, parents should apply pressure firmly to control the bleeding. About 5 percent of hemangiomas become ulcerated, especially if they are in an area that is under pressure or touched often.

Port-wine stains are on the forehead, sides of the face, or eyelids. They are occasionally linked with an increase of blood vessels in the brain or glaucoma. An increase in pressure in the eye can lead to blindness if not treated. Port-wine stains on the legs or arm may be linked to an overgrowth of that extremity.

Other complications, including congestive heart failure from large lesions, Kippel-Trenaunay-Weber syndrome, and Kasabach-Merrit syndrome, are rare.

Drugs

CORTICOSTEROIDS. Parents may consider treatment for hemangiomas that do not shrink or fade by the time the child is four years old. The treatments include the use of high doses of steroids (either orally or injected into the lesion) to stop the growth. Steroids prevent the marks from growing; they do not make the birthmarks smaller. Other treatments include interferon alpha, laser therapy, and surgical removal.

INTERFERON ALPHA-2A. This drug reduces cell growth in vascular marks that affect vision and that are unresponsive to corticosteroids. Given in daily injections under the skin, the response rate is 50 percent after seven months. Side effects include fever, chills, muscle and joint pain, vision disorders, low white and red blood cell counts, fatigue, elevated liver enzymes, nausea, blood clotting problems, and nerve damage.

ANTIBIOTICS. Oral or topical (applied to the skin) antibiotics are prescribed for infected marks.

Surgery

Birthmarks may be removed by laser surgery. Lasers create intensive heat that destroys abnormal blood vessels beneath the skin, without damaging normal skin. Laser surgery is not usually painful but can be uncomfortable. Children are usually sedated or anesthetized. Healing occurs within two weeks. Side effects include bruising, skin discoloration, swelling, crusting, and minor bleeding.

In some cases, the birthmark can be surgically excised, or removed. Under local or general anesthesia, the skin is cut and vascular marks or their scars are removed. The cut is repaired with stitches or skin clips.

Cryosurgery is another technique used to remove small birthmarks. Vascular marks can be frozen with a substance that is sprayed onto the skin. Wounds heal with minimal scarring.

Birthmarks can also be treated by electrodesiccation. In this procedure, affected vessels are destroyed with the current from an electric needle.

Other Treatments

Other treatments include the following:

• Sclerotherapy: Injection of a special solution causes blood clotting and shrinkage with little scarring. Side effects include stinging, swelling, bruising, scarring, muscle cramping, and allergic reactions. This treatment is used most commonly for spider angiomas.
• Embolization: A special material is injected into the vessel blocks blood flow, which helps control blood loss from a bleeding birthmark or reduces the size of inoperable growths. A serious side effect, stroke, can occur if a major blood vessel becomes blocked.
• Make-up: Special brands designed to cover birthmarks are sold. Two of these are Covermark and Derma blend.
• Cleaning and compression: Bleeding marks are cleaned with soap and water or hydrogen peroxide, and compressed with a sterile bandage for five to 10 minutes.

Prognosis

Many birthmarks fade or disappear before the child is school age. Some may never go away. Most of them are benign and do not need treatment. Babies with birthmarks are examined and diagnosed by the doctor. Those birthmarks that cause complications in normal childhood growth and development may require medical and surgical treatment.

The various types of birthmarks have different prognoses:

• Capillary hemangiomas: Fewer than 10 percent need treatment. Without treatment, 50 percent disappear by age five; 70 percent by age seven; and 90 percent by age nine. No skin changes are found in half, while others have some discoloration, scarring, or wrinkling. From 30 to 90 percent respond to oral corticosteroids, and 45 percent respond to injected corticosteroids; 50 percent respond to interferon Alpha-2a. About 60 percent improve after laser surgery.
• Cavernous hemangiomas: Many do not disappear and are complicated by ulceration or infection. About 75 percent respond to laser surgery but have scarring.
• Spider angiomas: These fade in children but may recur. About 90 percent respond to sclerotherapy, electrodesiccation, or laser therapy.
• Cherry angiomas: These are easily removed by electrodesiccation.
• Lymphangiomas: These marks require surgery.
• Salmon patches on eyelid marks: These marks disappear by six to 12 months of age, and forehead marks fade by age six; however, 50 percent of stork bites on the neck persist into adulthood.
• Port-wine stains (flat birthmarks): These marks are easily covered with make-up. Treatment during infancy or childhood improves results. About 95 percent of the stains respond to FPDL surgery with minimal scarring; 25 percent will disappear, and 70 percent will partially disappear. For unknown reasons, 5 percent show no improvement.

Prevention

Birthmarks are congenital hemangiomas or vascular malformations and cannot be prevented.

Parental Concerns

Though no treatment is needed in many of these cases, a child with a hemangiomas should be watched carefully by a doctor skilled in pediatric skin disorders. The hardest part for parents is to wait until the birthmarks begin to fade on their own or, in the case of a birthmark that does not fade, waiting until the child is old enough for surgical management.

When to Call the Doctor

Parents should report any birthmarks they notice to the child's pediatrician. They should call the pediatrician if they notice bleeding from the birthmark, if a sore develops on the birthmark, if the mark is growing larger.

Resources

Books

Birthmarks: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, CA: Icon Group International, 2004.

Thompson, June. Spots, Birthmarks, and Rashes: The Complete Guide to Caring for Your Child's Skin. Westport, CT: Firefly Books, 2003.

Web Sites

"Birthmarks: Red." MedlinePlus, April 17, 2003. Available online at www.nlm.nih.gov/medlineplua/ency/article/001440.htm (accessed December 12, 2004).

[Article by: Aliene S. Linwood, RN, DPA, FACHE]

• Defects and Disabilities - birthmark: skin blemish present at birth, often diminishing in size over time; nevus

Dansk (Danish)
n. - modermærke

Nederlands (Dutch)
moedervlek, wijnvlek

Français (French)
n. - tache de vin, nævus, angiome

Deutsch (German)
n. - Muttermal

Ελληνική (Greek)
n. - εκ γενετής σημάδι

Italiano (Italian)
voglia

Português (Portuguese)
n. - marca (f) de nascença

Русский (Russian)
родимое пятно

Español (Spanish)
n. - marca o mancha de nacimiento

Svenska (Swedish)
n. - födelsemärke

中文（简体）(Chinese (Simplified))
胎记, 胎痣

中文（繁體）(Chinese (Traditional))
n. - 胎記, 胎痣

한국어 (Korean)
n. - 모반

日本語 (Japanese)
n. - 母斑, 特徴
v. - …にあざを付ける

العربيه (Arabic)
‏(الاسم) وحمه, شامه‏

עברית (Hebrew)
n. - ‮סימן מלידה (על הגוף)‬

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