Understanding Newborn Birthmarks: Pediatrician’s Explanation Dr. Rashmi Jain September 8, 2023

Understanding Newborn Birthmarks: Pediatrician’s Explanation

newborn birthmarks

1. Different types of Newborn Birthmarks
        • 1.1 Salmon Patch
        • 1.2 Port Wine Stains
        • 1.3 Venous Malformations
        • 1.4 Hemangiomas
        • 1.5 Nevi (moles)
        • 1.6 Café-Au-Lait Spots
        • 1.7 Mongolian Spots
        • 1.8 Hypopigmented Macules
2. Final Thoughts

Often time, birthmarks may be visible right at birth or appear in the first few months of a child’s life. Some types of newborn birthmarks occur because of an abnormal collection of blood vessels, while others develop because of the maldistribution of pigment cells.

It is unknown what causes most birthmarks, though some (very few) run in families. They cannot be prevented and are not caused by anything done or not done during pregnancy. They are generally not connected to trauma of the skin during childbirth. 

It can be upsetting to see a mark on your newborn baby, but most newborn birthmarks are inconsequential and only require treatment if desired for cosmetic reasons. Many will eventually fade as the child ages. Occasionally, the location, size, or number of birthmarks calls for a closer evaluation of possibly associated conditions. Your doctor will be able to tell you which birthmarks demand a better look. If your child’s birthmark bleeds, hurts, itches, or becomes infected, call your healthcare provider.

Different Types of Newborn Birthmarks

Salmon Patch

About one-third of babies are born with one or more salmon patches. Common locations are either “stork bites” at the nape of the neck or “angel kisses” on the forehead between the eyes, nose, upper lip, or eyelids.

These birthmark types in babies look like small, pink, flat marks on the skin and are a collection of tiny malformed blood vessels. Frequently, when babies cry or get fussy, these marks appear darker. Many of these patches will fade away in the first year of life.

However, some, especially on the nape of the neck or on the lower back, may persist indefinitely. These patches are not associated with other conditions and no further evaluation is required.

Port Wine Stain

Port Wine Stain is visible in 0.2 to 0.3 percent of newborns. These marks also result from malformed blood vessels but tend to persist into adulthood. They start as flat pinkish-red marks and progress to thicker purple-red marks that often, though not exclusively, appear on the face. 

Understanding Port Wine Stain

Sometimes as these marks progress, they may be accompanied by nodules, or raised mounds of skin, underlying the discoloration. Depending on the location of the Port Wine Stain, on occasion, they are associated with syndromes that include features of seizures, glaucoma, developmental delay, and difficulty with limb movement. Those located on the eyelid, especially, can increase the risk of glaucoma. Infants with Port Wine Stain should be thoroughly examined for the possibility of further testing. 

Port Wine Stain Removal

In the past, masking cosmetics and skin grafts helped with temporary or incomplete camouflage of the port wine stains. Recently, pulsed-dye yellow laser therapy has proven to be successful in permanently removing the discoloration of Port Wine Stain by disrupting the blood vessels that form them. The technique has little risk of scarring and is relatively painless. It may require multiple treatment sessions. Some of the birthmarks that penetrate deeper into the skin may not show as much improvement. Treatment in early childhood, however, brings the best results and requires fewer treatments!

Venous Malformations

They appear in 1 to 4 percent of babies and may not be visible until later in life. These birthmarks in infants are blue or purple and may look like little dots in the skin or, if larger, they may look like bruises under the skin that don’t go away. If the malformation goes a little deeper, it can have a ropy texture to it.

Dilated veins generally cause these marks and are often found on the face and mouth or in the limbs. It is also possible to have these birthmarks in babies on internal organs like the intestines or brain.

These continue to grow with time and are often accompanied by swelling and pain in nearby joints and bones. Sometimes compression garments help reduce symptoms, and other times special therapy or surgery is required to destroy these veins. 

Strawberry Hemangioma

Strawberry Hemangioma is yet another type of birthmark stemming from closely packed blood vessels. They occur in up to 10 percent of infants by one month of age and tend to be more common in girls and preemies. They may start as flat red marks that rapidly grow in the first year of life. They usually appear on the face, scalp, back, or chest. 

Understanding Strawberry Hemangioma

Often, Strawberry Hemangioma will be raised and compressible with demarcated borders leading to the historical name “strawberry hemangioma,” or they may lie underneath the skin leading to the categorization of a “cavernous hemangioma.”

In either case, by about 12 months of age, hemangiomas begin to involute and get gray. They flatten out and slowly regress completely. Fifty percent are entirely gone by 5 years of age, and 90 percent are gone by 9 years of age. Sometimes after the hemangioma vanishes, loose skin or scarring may remain. 

Treatment for Strawberry Hemangioma

Though strawberry hemangioma rarely requires treatment, it can be dangerous if they are located near the airway, eye, or any other part of the body where that initial growth of the hemangioma might affect sight, breathing, feeding, or any other bodily function. Other locations might make the marks prone to bleeding or infections. In these cases, either steroid therapy or pulsed-dye laser therapy can help shrink the hemangioma.

Widespread or rapidly growing hemangiomas may be related to underlying syndromes that also affect the heart and blood flow. Again, in these situations, your physician may recommend further testing.

Nevi Moles

Moles result from an abnormal clustering of skin cells. One in every 50 to 100 people is born with a small nevus. They may be flesh-colored, reddish, brown, or black and can range in size from pinpoint to sometimes covering half of a baby’s body! Nevi may fade or disappear over time but need to be watched closely as they may carry an increased risk of becoming skin cancer.

Usually, growth in size, change in shape, darkening of color, increase in number, or irregularity of borders warrants your doctor’s evaluation. Sun exposure may cause the darkening of nevi and, of course, sunscreen is always recommended (over the age of 6 months) to prevent skin cancer and reduce the development of acquired nevi. Depending on the size and location, some nevi can lead to itching, bleeding, and pain, which may lead to the need for treatment. Surgical removal is usually reserved for those moles that raise suspicion.

Cafe-Au-Lait Spots

Cafe Au Lait birthmark types are flat, smooth, tan, or brown colored oval birthmarks that appear in 10 to 20 percent of individuals either at birth or in childhood. They result from an abnormal clustering of pigment cells, and their color is how they earned the name “coffee with milk” in French. Some may be as small as freckles, while others might be more than 20 centimeters in diameter. They usually occur on the torso, buttocks, and legs but may occur on any area of the skin. They may also get bigger and darker with age. 

Treating Cafe Au Lait

Though they are generally not worrisome, if an individual has more than six spots or if the spots are larger than the diameter of a quarter, they can be associated with syndromes, such as neurofibromatosis. This syndrome can cause bone abnormalities and speech problems. This disorder is also associated with high blood pressure, vision problems, and epilepsy. These circumstances would require further investigation by your doctor.   

Mongolian Spots

Mongolian Spots, more formally known as congenital melanocytosis, these birthmarks are flat, smooth, irregularly shaped blue-green birthmarks often found on the buttocks and lower back. There tends to be a higher occurrence in African-American, Asian-American, and darker-skinned babies.

At times their appearance resembles that of a flat bruise that doesn’t go away. There is no treatment required for Mongolian spots. By 3 to 5 years of age, they are often camouflaged by normal pigment cells.

Mongolian spots, too, form because of abnormal clustering of pigment cells, but these cells are clustered in a different layer of skin than the cells that create cafe-au-lait spots. 

Hypopigmented Macules

Also known as “ash-leaf spots,” these are flat, smooth, sometimes oval, and sometimes irregularly shaped birthmarks that are devoid of color and appear whitish. They are most common on the torso and lower limbs. Single hypopigmented macules present in 0.1 percent or more of newborns and may be markers for a syndrome associated with seizures and tumors on the brain. This is not always the case, though, and your doctor can help evaluate them.

Final Thoughts

There are many types of newborn birthmarks. Very often, they are simple, non-threatening companions through childhood and, at times, through one’s whole life.

If your infant has marks on his or her skin that have you concerned, don’t hesitate to book an appointment with your pediatrician or online with a babiesMD pediatrician. A medical professional can ease your mind and also ensure your child’s health is supported in the best way possible. These marks might “mark” the start of a search that leads your child to the resources they need to get off to a smooth start in life. As the saying goes — “On your mark, get set, go!”