Birthmarks

Birthmarks are benign (noncancerous) skin growths composed of rapidly growingor poorly formed blood vessels or lymph vessels. Found at birth (congenital)or developing later in life (acquired) anywhere on the body, they range fromfaint spots to dark swellings covering wide areas.

Skin angiomas are composed of either blood vessels (hemangiomas) or lymph vessels (lymphangiomas)that lie beneath the skin's surface. Hemangiomas (strawberry marks) are found on the face and neck (60%), trunk (25%), or the arms andlegs (15%). Congenital strawberry marks, 90% of which appear at birth or within the first month of life, grow quickly, and disappear over time. Lymphangiomas are skin bumps caused by enlarged lymph vessels anywhere on the body.

Vascular malformations are poorly formed blood or lymph vessels that appear at birth or later in life. One type, the salmon patch a pink mark composed ofdilated capillaries (tiny blood vessels), is found on the back of the neck (also called a stork bite) in 40% of newborns, and on the forehead and eyelids(also called an angel's kiss) in 20%.

Found in fewer than 1% of newborns, port-wine stains are vascular malformations composed of dilated capillaries in the upper and lower layers of the skinof the face, neck, arms, and legs. Often permanent, these flat pink to red marks develop into dark purple bumpy areas in later life.

Hemangiomas acquired later in life include spider angiomas (spider veins), and cherry angiomas. Found around the eyes, cheekbones, arms, and legs, spiderveins are red marks formed from dilated blood vessels. They occur during pregnancy in 70% of white women and 10% of black women, in alcoholics and liver disease patients, and in 50% of children. Cherry angiomas, dilated capillariesfound mainly on the trunk, appear in the 30s, and multiply with aging.

There are no known causes for congenital skin angiomas. Exposure to estrogencauses spider veins in pregnant women or those taking oral contraceptives. Spider veins also tend to run in families, and may be associated with liver disease, sun exposure, and trauma.

Hemangiomas first appear as single or multiple white or pale pink marks, ranging from 2-20 cm (average 2-5 cm) in size. Some are symptomless while otherscause pain, bleed, or interfere with normal functioning because they are numerous, enlarged, infected, or ulcerated. Vision is affected by large marks onthe eyelids. Spider and cherry angiomas are unsightly but symptomless.

Vascular malformations (port wine stains, salmon patches, storkbites) may besymptomless or bleed if enlarged or injured. Disfiguring port-wine stains cancause emotional and social problems.

Patients with birthmarks are treated by pediatricians, dermatologists, plastic surgeons, and sometimes ophthalmologists. Angiomas and vascular malformations are not difficult to diagnose. The doctor takes a complete medical historyand performs a physical examination. Biopsies or specialized x rays or scansof the abnormal vessels and their surrounding areas may be performed. Patients with port-wine stains near the eye may require skull x rays, computed tomography scans, vision, and central nervous system tests.

Treatment choices for skin angiomas and vascular malformations depend on their type, location, severity, and whether they cause pain, or disfigurement. Often, no treatment is needed, but the mark is regularly examined until the mark disappears, or requires treatment. This approach is particularly appropriate for the treatment of strawberry marks which often shrink by themselves.

The anti-inflammatory steroid drugs prednisone or prednisolone may be used totreat some birthmarks. The marks begin to subside within 7-10 days, but maytake up to 2 months to fully disappear. If no response is seen in 2 weeks, the drug is discontinued. Corticosteroids may also be injected directly into the marks with a response usually achieved within a week. These drugs may havesubstantial undesirable side effects and may not be appropriate for everyone.

Interferon Alpha-2a is used to reduce cell growth for vascular marks that affect vision, and that are unresponsive to corticosteroids. Oral or topical (applied to the skin) antibiotics are used on infected marks.

Laser surgery destroys abnormal blood vessels beneath the skin without damaging normal skin. The laser used to treat strawberry marks and port-wine stainspenetrates to a depth of 1.8 mm and causes little scarring. Another type oflaser that penetrates to a depth of 6 mm is used to treat deep hemangiomas. Laser surgery is usually not painful, but can be uncomfortable. Healing occurswithin 2 weeks. Side effects include bruising, skin discoloration, swelling,crusting, and minor bleeding.

Surgical excision of the birthmark may be performed under local or general anesthesia. The skin is cut and vascular marks or their scars are removed. Thecut is repaired with stitches or skin clips. In cryosurgery, vascular marks are frozen with an extremely cold substance sprayed onto the skin. Wounds healwith minimal scarring.

Other treatments include electrodesiccation, where affected vessels are destroyed with current from an electric needle; sclerotherapy, where injection ofa special solution causes blood clotting and shrinkage with little scarring;and embolization, where material injected into the vessel blocks blood flow to reduce the size of inoperable growths. Special make-up (Covermark or Dermablend) is also available to cover birthmarks.

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