Birthmarks: Diagnosis and treatment

How do dermatologists diagnose a birthmark?

Often, a dermatologist can tell you what type of birthmark your child has by examining it.

To examine a birthmark, your dermatologist may use an instrument called a Wood’s lamp. This device lets a dermatologist see parts of the skin that cannot be seen with the naked eye. This won’t hurt. It’s just a special light.

If your child has many birthmarks, your dermatologist may recommend some testing.

Having a lot of birthmarks can be a sign of something going on inside your child’s body. For example, if a child has many café-au-lait spots, your child could have neurofibromatosis. This is a disease that can cause tumors on the nerves. To rule this out, your child may need an X-ray or CT scan.

Most of the time, however, a dermatologist only needs to look closely at the birthmark. After the exam, your dermatologist can tell you the:

• Type of birthmark your child has

• Precautions, if any, to take

• Treatment, if any, that’s recommended

How do dermatologists treat birthmarks?

While you can leave most birthmarks alone, it’s important to see a dermatologist soon after you notice a birthmark. Some birthmarks can cause a problem later on. Treatment can prevent that.

Your dermatologist may recommend treatment if your child has a:

• Strawberry hemangioma on the face or groin: This birthmark tends to grow quickly before fading. If one appears near your child’s eye, mouth, or nose, treatment can prevent it from covering that part of your child’s body. In the groin area, treatment can prevent pain later on.

• Port-wine stain: This birthmark will not go away with time. It can grow and thicken. Early treatment tends to be more effective.

• Very large or visible birthmark: If the birthmark affects the child’s appearance and could cause problems with self-esteem, your dermatologist may recommend treatment.

The safest and most effective treatment varies with the birthmark and child. Here’s what your dermatologist may recommend:

• Watch the birthmark: While not a treatment, this offers parents an important option. With this approach, parents watch the birthmark carefully. Your dermatologist will tell you what to look for. This allows you to treat the birthmark only if treatment becomes necessary. This can be an effective approach for a strawberry hemangioma, a type of birthmark that can grow quickly.

• Laser therapy: This may be an option for a port-wine stain, a type of birthmark that won’t go away with time.

• Propranolol: This medication can effectively prevent a hemangioma from growing. It can also shrink a growing hemangioma. A special formulation of this drug has proven effective for treating children with large hemangiomas. This drug has been approved to treat this type of birthmark.
  
  Heart medicine can clear strawberry birthmarks

• Timolol: This medication can also help shrink a growing hemangioma. It comes in liquid form, so you’d apply it to your child’s birthmark. It’s commonly used to treat babies who have glaucoma. When used to treat a hemangioma, dermatologists prescribe a lower dose of the medication than would be used to treat glaucoma.

• Corticosteroid: This medication may be used to shrink a hemangioma. Your child’s dermatologist may prescribe pills or inject the birthmark with this medication.

• Interferon: If your child has a life-threatening birthmark, this may be an option. Your child would need daily shots, so you’d learn how to give these. You’ll also have to watch your child carefully for possible side effects.

• Surgery to remove the birthmark: This type of surgery can be used to cut out a birthmark. It may be recommended if your child has a birthmark that could become a skin cancer, such as a mole. When mole removal is recommended, it is often done when the child reaches puberty. Surgery can also be helpful for treating a large raised birthmark that won’t go away on its own and affects your child’s appearance.

• Makeup: This may be the right approach for an older child or adult. The right makeup can cover discolored skin. If you have trouble finding makeup that can hide a birthmark, ask your dermatologist for a recommendation.

What is the outcome for a child’s birthmark?

Many birthmarks fade on their own. Common birthmarks like hemangiomas tend to fade without treatment. Though hemangiomas can grow a lot bigger before they start to fade.

Birthmarks that don’t fade with time include café au lait spots, moles, and port-wine stains. They are usually harmless. If one affects a child’s appearance, treatment may be an option.

Related AAD resources

• Heart medicine can clear strawberry birthmarks

• Hiding child's skin condition with makeup may boost self-esteem

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References
American Academy of Dermatology. “Red, white and brown: Defining characteristics of common birthmarks will determine type and timing of treatment.” News release issued Feb 4, 2011.

Barnhill RG and Rabinovitz H. “Benign melanocytic neoplasms.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1713,1720-3.

Del Pozzo-Magana B, Dizon M, et al. “Newborn skin disease, Part 1: Birthmarks.” In: Society for Pediatric Dermatology and the American Academy of Dermatology’s Basic Dermatology Curriculum. Peer review by: Maguiness S. May 2016.

Enjolras O. “Vascular malformations.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1582-5.

Garzon MC “Infantile hemangiomas.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1567-8.

Habif TP, Campbell TL, et al. “Hemangiomas of infancy.” In: Dermatology DDxDeck. Mosby Elsevier, China, 2006: Card 140.

Helwick C. “Timolol gel effective for infantile capillary hemangiomas.” Medscape News. Nov 2012. Last accessed September 2017.

McCalmont TH. “Adnexal neoplasms.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1695-6.