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Birthmarks: Overview of types, diagnosis and treatment

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Your question:
My granddaughter was born with a port wine birthmark, which looks quite severe. My daughter has been told that it will not fade. It is all down the left side of my granddaughter's face and back. What causes this and what can be done about it? The expert answers:
There are many types of birthmarks that newborns may have. Fortunately, most of these will fade with time.

Salmon patches
Among the most common birthmarks are simple salmon patches. These are present at birth and may occur on the nape of a baby's neck, where they are called a stork bite. Another common location for a salmon patch is the eyelids or on a baby's forehead, where it is called an angel's kiss.

A salmon patch is usually flat and blotchy, with a red or pink color that often gets darker when your baby is crying. Unlike some other types of birthmarks, these usually fade by the time a baby is a year old and they don't require any treatment.

Strawberry Hemangioma
Often referred to simply as "strawberries," these are another common type of birthmark. Surprisingly, they aren't always visible at birth. Many don't actually appear until later in a newborn's first month of life.

Although flat when they first appear, like a salmon patch, they then begin to grow and reach a peak in size when a child is about 18 months old. They often have a bright red color, although they may be bluish early on. After they stop growing, they often change color a little, becoming more grayish, and then start getting smaller or involuting.

Many hemangiomas completely involute by the time a child starts school, usually without any form of treatment. Others do need early treatment because they can be disfiguring or dangerous, like a large hemangioma near a baby's eye that may interfere with her eyesight or on her nose, since it can interfere with her breathing.

A hemangioma may also need to be treated if it grows very rapidly (Kasabach-Merritt Syndrome). And children with more than three hemangiomas may need imaging to look for internal hemangiomas, which can also lead to problems if undetected and not treated.

Port wine stain
Unlike these other types of vascular birthmarks, a port wine stain is permanent and won't go away when your baby gets older. In fact, it will likely get darker and thicker over time, changing from a pink or red color at birth to a deeper red or purple color in adulthood.

Like your granddaughter's port wine stain, they often occur on one side of a child's face, although they can occur any where on the body.

In addition to the cosmetic effect of a port wine stain, there is a concern for other medical conditions. Children whose port wine stain involves their eye may have Sturge-Weber Syndrome, which can also be associated with seizures, mental retardation and glaucoma. If your child's birthmark extends up over her eye, then she should see a Pediatric Ophthalmologist and have an MRI of her head.

If the port wine stain is on a child's arm or leg, they can develop Klippel-Tr�naunay-Weber syndrome and have an overgrowth of tissue in that limb.

Even if she doesn't have Sturge-Weber Syndrome, she should see a specialist to discuss the treatment options for children with a port wine stain, which include use of a pulsed dye laser. A pediatric dermatologist or a pediatric plastic surgeon would be among the specialists that could treat your child.

Although the timing of when laser treatments should be started is controversial, many specialists do recommend that you start very early, even before an infant's first birthday, to get the best results. Keep in mind that multiple treatments will be required and that the treatments will likely be done using general anesthesia because the treatments can be painful.

As to the cause of port wine stains, it is now thought that they form because of some deficiency of nerves in skin that controls how blood vessels form. It is still not known why that happens though, although it is not usually thought to be genetic.

For more information, please see the Vascular Birthmarks Foundation, which includes before and after photos of children with many different types of birthmarks.

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