What birthmarks really mean
We uncover the mystery surrounding strawberry smudges, café au lait spots and other newborn blemishes that may surprise you. 
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A birthmark, as the name suggests, is a marking on the skin present at birth or which appears shortly after birth. Birthmarks vary in size and shape, and can be blue, black, tan, brown, pink, red, purple and even white. Some are smooth, and some are raised and rough, but mostly, birthmarks are painless and harmless. They are not punishment for anything you or your baby did at any point, and don’t indicate a latent power.

Often, birthmarks fade over time without treatment. However, some can be permanent and unsightly, which can create cosmetic concerns for those affected. Some birthmarks may even serve as indicators of underlying health issues. To be extra safe, it’s important to have a doctor check your baby’s birthmarks, especially if there are rapid changes in appearance.

What's that patch?

Pigmented birthmarks are the result of pigmentation inconsistencies in the skin and include:

Congenital (at birth) moles

These moles are usually brown to brownish black, can vary in size and shape, and can grow anywhere on the body. Dr Gary Levy, specialist dermatologist and member of the South African Melanoma Advisory Board, says, “They are classified according to size– small, medium and large (known as giant) congenital naevi. A small percentage of these birthmarks could become cancerous in adulthood. It is the giant ones (greater than 20cm in diameter in adulthood) that are most at risk for cancerous change.” For that reason, they must be carefully watched for changes in size, shape or colour as your baby grows.

Café au lait spots

These are like dashes of extra melanin (a natural brown pigment) splashed across the skin. They are smooth, roundish birthmarks, and range in colour from light brown to chocolate. They are usually found on the upper body, buttocks and legs. They rarely change except possibly to get a little darker, and when they do change, there’s no real cause for concern. “More than five café au lait spots might be a skin marker for a disorder called neurofibromatosis, so if your child has many of these spots, consult a paediatrician,” says Dr Levy.

Mongolian spots

An odd name, but these birthmarks are usually found on dark-skinned babies, are often uneven in shape, and appear on the lower back, legs and buttocks. They are usually the colour of a bruise (blue or blue-grey) and many children may have more than one. These spots are identifiable at birth and almost always fade by age five. Only five percent of children with Mongolian spots will have them for life. These spots are totally harmless and do not suggest any other type of syndrome.

How are these treated?

Pigmented birthmarks are generally harmless and are usually left alone, with the exception of moles and occasionally café-au-lait spots. If a mole exhibits potentially cancerous changes, a biopsy may be performed. Large or prominent moles that affect appearance can be concealed with special cosmetics. Always take your baby to a doctor if you notice a change in colour, size, or texture of a mole or other skin lesion.

Shapes and forms

Vascular lesions are usually benign growths that are formed when the cells that line the blood vessels start dividing and multiplying at an abnormal rate. They are often noticed soon after birth, grow rapidly, and then stop growing and start getting smaller. While most will disappear on their own, some vascular lesions can remain throughout life. They may appear anywhere on the body in many shapes, sizes and thicknesses, and can also occur deeper in the body, affecting internal organs. They are most commonly found on the face, scalp, back and chest. They include:

Infantile haemangiomas 

These are among the most common birthmarks in children and the most common benign tumour in children. Approximately two and a half percent of newborns have haemangiomas. They are more common in girls, fair-skinned people, and premature babies.

Stork bites

Also known as salmon patches or nevus simplex, these marks are usually light pink or red, and flat. Typically, they appear on the back of the neck, the upper lip, between the eyebrows and on the upper eyelid. They can be present at birth, or may appear in the first months of life. They occur in about one third of fair-skinned babies and usually fade by the age of five.\

Strawberry marks 

Although they look like a flattened version of its namesake, the real name for these birthmarks is capillary haemangioma and they can be found on two percent of newborn babies. Strawberry marks very often disappear by the time a child is of schoolgoing age, but see your doctor if any strawberry marks appear around your baby’s eyes, nose, or mouth.

Port-wine stains

Ranging in size from a small coin to covering a large area of the body, these large birthmarks are usually dark red or purple in colour, and are generally flat and smooth. They are caused by an extensive network of blood vessels near the surface of the skin, which did not grow normally. In time, port-wine stains can become darker, thicker and bumpier. Port-wine stains can be found on the neck, face and scalp and occurs in about half a percent of all newborns. “Most port-wine stains are harmless,” says Dr Levy. “But if you find one near the eyelids an MRI scan should be done as these might be part of a few syndromes which are associated with underlying abnormalities of the brain and the eye. Should your baby have one of these port-wine stain birthmarks, it is important that they see a doctor.”

How are these treated?

Most haemangiomas are small and harmless, but if your baby has multiple haemangiomas, they might require evaluation by a specialist because of the risks of involvement of the internal organs and the risk of congestive heart failure. Even a small haemangioma on the upper eyelid can permanently affect a child’s vision and requires evaluation by a vascular anomalies specialist and a paediatric ophthalmologist.

When to see your doctor

Although most birthmarks are harmless, many dermatologists recommend getting them checked by a doctor to ensure there isn’t an underlying disorder. It may be necessary to treat a birthmark if it:

  • Changes in size, shape or colour 
  • Starts to itch, burn, hurt or sting 
  • Develops bumps or sores 
  • Bleeds at all 
  • Interferes with normal activity 
  • Causes dissatisfaction with your baby’s appearance

It's all about location

Many of the associated risks of haemangiomas are related to their location on the body. But there are some haemangiomas that should be evaluated by a vascular anomalies specialist at a hospital. Seek help if the mark is here:

  • If the mark covers a large segmentof the face.
  • Tip of the nose or ear.
  • If it’s a deep haemangioma ona large part of the face.
  • Around or behind the eye.
  • In the “beard area” and centre ofthe neck.
  • Around the mouth or on the lips.
  • Over the lower spine.
  • Perianal (around the anus), underarm, or neck creases.
  • Multiple haemangiomas.

Most haemangiomas should disappear by the time your child is nine years old. However, a minority of children will have a more troublesome haemangioma that requires the help of a specialist.

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