Birthmarks: Treatment

Treatment choices for skin angiomas and vascular malformations depend on their type, location, and severity, and whether they cause symptoms, pain, or disfigurement.

No treatment is given, but the mark is regularly examined. This continues until the mark disappears, or requires treatment. This approach is particularly appropriate for the treatment of hemangiomas, which often do not require treatment, since they eventually shrink by themselves.

CORTICOSTEROIDS. Daily doses of the anti-inflammatory drugs prednisone or prednisolone are given for up to 2 months with gradual reduction of the dose. The marks begin to subside within 7-10 days, but may take up to 2 months to fully disappear. If no response is seen in 2 weeks, the drug is discontinued. Treatment may be repeated. Side effects include growth retardation, increased blood pressure and blood sugar, cataracts, glandular disorders, and infection. The corticosteroids triamcinolone acetate and betamethasone sodium phosphate or acetate are injected directly into the marks with a response usually achieved within a week; additional injections are given in 4-6 weeks. Side effects include tissue damage at the injection site.

INTERFERON ALPHA-2A. This drug reduces cell growth, and is used for vascular marks that affect vision, and that are unresponsive to corticosteroids. Given in daily injections under the skin, a response rate of 50% is achieved after about 7 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.

LASER SURGERY. Lasers create intense heat that destroys abnormal blood vessels beneath the skin, without

damaging normal skin. Two types of lasers are used: the flashlamp-pulsed dye laser (FPDL) and the neodymium:YAG (Nd:YAG) laser. The FPDL, used mainly for strawberry marks and port-wine stains, penetrates to a depth of 1.8 mm and causes little scarring, while the Nd:YAG laser penetrates to a depth of 6 mm, and is used to treat deep hemangiomas. Laser surgery is not usually painful, but can be uncomfortable. Anesthetic cream is used for FPDL treatment. Treatment with the Nd:YAG laser requires local or general anesthesia. Children are usually sedated or anesthetized. Healing occurs within 2 weeks. Side effects include bruising, skin discoloration, swelling, crusting, and minor bleeding.

SURGICAL EXCISION. Under local or general anesthesia, the skin is cut with a surgical instrument, and vascular marks or their scars are removed. The cut is repaired with stitches or skin clips.

CRYOSURGERY. Vascular marks are frozen with an extremely cold substance sprayed onto the skin. Wounds heal with minimal scarring.

ELECTRODESICCATION. Affected vessels are destroyed with the current from an electric needle.

These include:

• 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. Material injected into the vessel blocks blood flow which helps control blood loss during 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 are designed to cover birth-marks (Covermark or Dermablend).
• Cleaning and compression. Bleeding marks are cleaned with soap and water or hydrogen peroxide, and compressed with a sterile bandage for 5-10 minutes.

— Mercedes McLaughlin