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18 July 2009
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Red birthmarks

My granddaughter has been born with a large red birthmark, but the doctors seem very casual about it and say that it won't need any treatment and will go on its own. Given the fact that it's a huge red mark across her neck, we find it hard to believe that there isn't something medicine can do for her.

Caroline

Dr Trisha Macnair responds

Dr Trisha MacnairI'm sorry the doctors seem casual about something that's clearly giving you and your family a lot of worry. Talk to them again and see if they can give you a better explanation of what the birthmark is, and what will happen to it with time.

Ask if you can see some pictures of how the marks improve - there are plenty of 'before' and 'after' pictures in textbooks or on the internet to reassure you.

I expect the reason why they seem so casual is that birthmarks are common, and most disappear within a few years without any need for treatment. As the doctors have explained, it will go on its own. Any attempt to remove it now runs an unnecessary risk of complications or scarring.

Tiny babies have no idea that they have a strange red mark on their skin, or that others might consider this unusual, so they're rarely troubled by birthmarks.

Of course, if the mark is very conspicuous, and lasts into toddler years, your granddaughter may become more aware of it. But, again, treatment may not be the best option. Instead, it's usually better to simply play it down as far as possible, and make efforts to ensure everyone at home and school understands it's quite normal, and will go away eventually.

Types of red birthmark

There are several different types.

Most common are stork marks - flat pink areas at the back of the neck, or between the eyebrows, which become more vivid when the baby cries. These fade quickly, usually over a few months.

Strawberry naevi are bright red, lumpy and soft lesions with small white dimples on the surface. They usually appear soon after birth, and often steadily enlarge in the first few months. They're caused by abnormal blood vessels, which grow bigger in response to oestrogen passed on to the baby from the mother while still in the womb.

Strawberry naevi can look quite frightening and disfiguring to parents, but these are best left alone because they clear up completely, with no scars, in most cases. Slowly, the lumps become paler and flatter until they disappear. By the age of six years they're usually completely gone.

One mark is permanent

There's one type of red birthmark that's permanent, called a port wine stain. These marks, formed by abnormal blood vessels, are named because they're flat and purple and look like a spill of wine on the skin. With age they may become thicker and darker in colour.

Its important you check with your doctor while your child is still young whether a birthmark is a port wine stain for two reasons :

  • Sometimes a port wine stain can be one visible sign of a syndrome of different problems. For example, a port wine stain around the eye and side of the face can be linked to an abnormality of the blood vessels in the brain. This condition, called Sturge-Weber syndrome can lead to blindness and epilepsy. Port wine stains around the eyelids may also be linked to glaucoma and problems with the optic nerve. Further tests may be needed to check for these possibilities.
  • Laser treatments, using a technique known as pulse dye laser or PDL, can be used to destroy the abnormal blood vessels and produce good results, with minimal scarring, but are best done while a child is still an infant, before the birthmark grows. The treatment is lengthy and expensive and may not be available on the NHS.

Cosmetic treatments, including skin creams which cover the mark (the British Red Cross offers a service to help with this) can help.

This article was last medically reviewed by Dr Trisha Macnair in November 2007

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