There are many different types of vascular birthmarks which present at birth or within a few weeks after birth. The most common are:

• Telangiectasia (stork marks or spider naevi;
• Port wine stains;
• Haemangiomas (Hemangiomas - US).

Telangiectasia

• Stork marks. These can present on the forehead, upper eyelids and on the back of the neck. They tend to be pale pink in colour. Stork marks, especially those on the upper eyelids, fade within two years. Those on the forehead may take up to four years to fade. The ones on the back of the neck usually persist.
• Spider Naevi. Individual marks which are superficial blood vessels, often have the appearance of a spider with a central darker red punctate with radiating blood vessels like thread veins, Others can be slightly raised from the surface of the skin as a red spot or diffused with a flat mark known as a matt telangiectasia.

Port wine stains

A port wine stain is a type of blood vessel birthmark which presents at birth as a uniform flat red, purple or pink mark on the skin, often on one side of the body, usually the face. Occasionally port wine stains can occur on both sides of the body. Sometimes this type of mark is referred as a naevus flammus.

Port wine stains are due to an abnormal development of blood vessels in that area of the skin. They are permanent stains and never go away. They are not inherited and therefore not passed from one generation to the next. They are not related to anything that the parents may have done during pregnancy.

The incidence of port wine stain is 3 in 1,000 children. They are twice as common in girls than boys. They may darken with age, thicken with raised bumps (papules) or ridges and increase in size proportionally to the child's growth.

Until two decades ago, the help that could be given was to cover the port wine stain with camouflage make-up. In recent years, the pulsed dye lasers have revolutionized the treatment of port wine stain with excellent results and minimal side effects. Following completion of laser therapy (two to four years later) 1 in 10 children may have a recurrence of their port wine stain. The child should have further treatment and usually the response is very good especially with the newer lasers that are now available which allow delivery of higher laser strength using the dynamic cooling device. This reduces the risk of skin change or superficial scarring.

Sometimes complications may occur with this type of birthmark. These may present as Glaucoma if the port wine stain is around the eye or Sturge-Weber syndrome if the mark extends onto the forehead or scalp. Occasionally the tissue around a port wine stain may enlarge causing soft tissue hypertrophy (on a lip, for example) or may be associated with extra growth of that limb called Klippel Trenaunay syndrome. For these associated conditions different specialists need to get involved so that the child can be treated appropriately.

Haemangiomas

The word haemangioma comes from the Latin words 'haem' meaning blood and 'angioma' meaning growth of cells. A haemangioma is a collection of small blood vessels that produces a lump in the skin. Haemangiomas can be superficial (capillary) or deep (cavernous). They are sometimes called strawberry marks. Approximately 1 in 10 babies have haemangioma, and they tend to be more common in girls, twins, triplets and premature babies or in mothers who presented with bleeding in pregnancy. They are usually not present at birth but develop a few days to weeks later. Initially there may be a small area of pale skin followed by a red spot. They grow rapidly in the first three months increasing in size and may intensify in colour. It is unusual for a haemangioma to grow after ten months. After this the haemangioma tends to have a rest period and will gradually improve with time. By the age of three years there are obvious signs of' reduction in size and most small haemangiomas will disappear leaving little or no mark on the skin by the age of five years. Large haemangiomas may continue to reduce in size up to seven to nine years of age.

Deep (cavernous) haemangiomas may appear bluish in colour because the abnormal blood vessels are deeper in the skin. Some haemangiomas may distort or stretch the skin around the lesion when it has completely disappeared. Sometimes there may be 'left over' fatty tissue following the regression of the haemangioma. In these situations, plastic surgery may be necessary.

Haemangiomas can appear anywhere on the body; rarely they can also he present in the internal organs. If this is the case, ultra sound scanning, magnetic resonance imaging (MRI), or rarely CT scan, may be indicated. Sometimes there can be more then one haemangioma in the same patient.

Most haemangiomas do not require any treatment, but some may need to be treated soon after birth if they interfere with feeding, breathing or other body functions. If the haemangioma presents on the child's eyelid, it may need urgent treatment in the first few weeks of life, as it may interfere with the development of the child's vision.

Some children with haemangiomas may require treatments with a pulsed dye laser, steroids or surgery. Those that have ulcerated or become sore may need to be admitted to hospital for treatment with antibiotics, dressings and regular nursing care.

Inheritance patterns
None.

Prenatal diagnosis
A huge congenital haemangioma may be identified on ultrascan towards the end of pregnancy. This can only be confirmed at birth. In this case the haemangioma is probably atypical and of the rare type, for example: NICH (Non Involuting Capillary Haemangioma); RICH (Rapidly Involuting Capillary Haemangioma); KHE with KMP (Kaposiform Haemangio-endothelioma with Kasabach Merritt Phenomena); or a Tufted Angioma. This group of haemangiomas need urgent review by a paediatrician or specialists working in the vascular birthmark units, for further management.

Medical text written August 2001 by Dr S B Syed. Last updated January 2006 by Dr S B Syed, Associate Specialist in Paediatric Dermatology, Great Ormond Street Hospital, London, UK.

BIRTHMARK SUPPORT GROUP

Birthmark Support Group
BM
London WC1N 3XX
Tel: 0845 045 4700
e-mail: info@birthmarksupportgroup.org.uk
Web: http://www.birthmarksupportgroup.org.uk

The Group is a National Registered Charity No. 1090952, established in 1998. It offers information, medical advice, coping strategies and an effective support network available to all family members. It runs four free family fun days a year which are spread all over the country and supported by medical and cosmetic professionals who give free advice and support. The group also has a group for adults (face it together) and one for teenagers (teentalk). They have approximately 800 members.

Group details last updated January 2007.