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Birthmarks - red

Definition

Red birthmarks are colored, blood vessel (vascular) skin markings that develop before or shortly after birth.

Alternative Names

Strawberry mark; Vascular skin changes; Angioma cavernosum; Capillary hemangioma; Hemangioma simplex

Causes, incidence, and risk factors

There are two main categories of birthmarks.

• Red birthmarks are made up of blood vessels close to the skin surface, and are called vascular birthmarks.
• 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. Their cause is unknown. The color results from the development of blood vessels at the site.

Strawberry hemangiomas (strawberry mark, nevus vascularis, capillary hemangioma, hemangioma simplex) may develop several weeks after birth.

Cavernous hemangiomas (angioma cavernosum, cavernoma) are similar to strawberry hemangiomas but they are deeper.

Salmon patches (stork bites) are extremely common, appearing on 30-50% of newborns.

A port-wine stain is a flat hemangioma made of dilated blood capillaries. Port wine stains on the face may be associated with Sturge-Weber syndrome.

Symptoms

• Skin markings that look like blood vessels
• Skin rash or lesion that is red

The different types of birthmark have their own appearance and typical location:

• Cavernous hemangiomas may appear as a red-blue spongy mass of tissue filled with blood.
• Port-wine stains are most often located on the face. The size varies from very small to over half of the body surface.
• Salmon patches are small, pink, flat spots. 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 on the back of the neck. Salmon patches may be more noticeable when the infant cries or during temperature changes.
• Strawberry hemangiomas may appear anywhere on the body, but are most common on the neck and face. They consist of small, closely packed blood vessels.

Signs and tests

A health care provider should examine all birthmarks. Diagnosis is based primarily on the appearance of the skin lesion.

Tests to confirm deeper birthmarks include:

• Biopsy
• CT scan
• MRI of the area

Treatment

Many strawberry hemangiomas, cavernous hemangiomas, and salmon patches are temporary and do not need treatment.

The nevus flammeus type of hemangiomas may not need treatment unless it is disfiguring, psychologically distressing, painful, or it changes in appearance.

Concealing cosmetics (such as Covermark) may hide permanent birthmarks.

Oral or injected cortisone may reduce the size of a hemangioma that is growing quickly and obstructing vision or vital organs.

Permanent birthmarks are usually not treated unless they cause unwanted symptoms, or until a child is at least school age. Port wine stains on the face are an exception. They should be treated at a young age with a yellow pulsed-dye laser, to prevent psychological and social problems.

Treatments include:

• Freezing (cryotherapy)
• Laser surgery
• Surgical removal

Support Groups

Expectations (prognosis)

Birthmarks rarely cause problems, other than cosmetic changes. Many birthmarks go away on their own by the time a child is of school age, but some are permanent.

Strawberry hemangiomas usually grow quickly, stay the same size, and then go away. Ninety-five percent of strawberry hemangiomas disappear by the time the child is 9 years old. However, there may be some slight discoloration or puckering of the skin where a strawberry hemangioma was.

Some cavernous hemangiomas disappear on their own, usually as a child approaches school age.

Port wine stains are often permanent.

Salmon patches often fade as the infant grows. Patches on the back of the neck may not fade, but are usually not noticeable as the hair grows.

Complications

• Emotional distress because of appearance
• Discomfort or bleeding from vascular birthmarks (occasional)
• Scarring or complications after surgical removal

Calling your health care provider

Have all birthmarks examined by a health care provider to determine the treatment, possible complications, and likely outcome.

Prevention

There is no known way to prevent birthmarks.

References

Habif TP. Vascular tumors and malformations. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 23.