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STRAWBERRY MARKS AND PORTWINE STAINS - VASCULAR BIRTHMARKS

Vascular birthmarks

These are birthmarks made up of abnormal blood vessels in the skin. The commonest is the so-called SALMON PATCH which affects one in every two new-born infants.

Salmon patches are found on the eyelids, the bridge of the nose, the upper lip and the nape of the neck (where they are called storkbites). They fade during infancy (except perhaps on the nape of the neck) and no treatment is required. More important are the rarer birthmarks, strawberry marks and port wine stains. Their features and treatment are discussed in this leaflet.

What are strawberry marks?

Strawberry marks affect 2% or more of babies. They are raised red soft lumps on the skin usually the size of a 50p piece and look like a strawberry. They are also called capillary haemangioma or cavernous haemangioma if they are deeper in the skin or appear blue in colour. The blood vessels in these birthmarks are increased in size and number.

Strawberry marks are not a sign of general ill health, and they are not connected with cancer. They can occur anywhere on the skin but are more important when they affect the face or the nappy area. These birthmarks are often not obvious at birth, but grow in the first month of life. Rarely they grow quite large and may bleed or become infected or ulcerated.

Why do they develop?

Strawberry marks are more common in premature babies. They seem to arise from "left over" groups of cells in the baby's skin. Many myths have developed about them but no parent should feel responsible for these blemishes.

Do strawberry marks disappear?

The birthmark may continue to grow for the first 3 to 6 months and sometimes for longer. Then they slowly shrink.

In 30% of children the birthmark will fade by the third birthday and by the fifth birthday in 50%. By the seventh birthday 70% will have faded. Shrinkage is not influenced by position, the size or the number of birthmarks. Sometimes the skin over the birthmarks remains rather thinned or baggy, after the haemangioma has shrunk. Plastic surgery can improve the appearance of there is a problem.

What treatments are available?

Usually no treatment is needed as most haemangioma will shrink on their won. Children are seldom aware of their blemishes before the age of three, and by then the birthmark will usually be fading. Large or troublesome strawberry marks in certain places, for instance near the eye, any need treatment to avoid affecting vision in that eye. Steroid medicine or injections shrink the blood vessels. Interferon given by injection is used in special cases. Rarely surgery is considered to reduce the size of the birthmark. Laser treatment can be used to speed up healing of ulcerated birthmarks and to stop bleeding but is not used routinely for these birthmarks.

Port wine stains
What are Port Wine Stains?

A port wine stain is a red or purple birthmark which affects one out of every 500 babies. Port wine stains are present at birth and grow with the child. They do not improve with time. They can occur on any part of the skin surface but cause most concern when they affect the face. They are also called naevus flammeus.

Why do they develop?

Port wine stains develop because the blood vessels in the affected skin lack small nerve fibres which are necessary to narrow them. The result of this is that the affected blood vessels are wide open with increased blood flow through the involved skin. This results in a permanent blush - port wine stain.

Do they change with age?

Yes, in babies and children, port wine stains are flat and pink. A people get older the blood vessels in port wine stains may become bigger and blood flows through them more slowly. At this stage, they look more purple than pink. Later, in adult life, port wine stains often develop bumpy areas which can make applying cosmetic camouflage difficult. Occasionally bleeding can occur in the bumpy areas if they are scratched.

Are there any associated problems?

Facial port wine stains can occasionally affect they eye or other underlying organs and in certain cases further investigation is necessary. If it occurs on an arm or leg, it is usual to check that the growth of the limb is normal.

Psychological problems

Port wine stains cause a lot of misery because they occur so often in visible areas important for body image, such as the face. A lot can be done to reduce the psychological impact including treatments discussed below, camouflage and advice from patient support groups.

Is treatment available and successful?

Usually - Yes! Treatment with the pulsed dye laser helps most patients although it may not clear the port wine stain completely. It is available in a few specialised centres in the UK. Port wine stains in older children can be treated under a local anaesthetic, often using an anaesthetic cream. Young children and those having very extensive areas treated especially around the eyes, need to have their laser therapy under a general anaesthetic or sedation.

Laser treatments lightens 90% or more of port wine stains in children. Depending on the size and site of the birthmark, up to 10 treatment sessions may be required at intervals of 8 weeks or so. Port wine stains on limbs respond less well than those on the face.

Cosmetic camouflage

Cosmetic or camouflage creams are often very helpful and expert advice is available in special British Red Cross clinics based at selected dermatology centres. Changing Faces and the Disfigurement Guidance Centre also offer a comprehensive service for patients and their families with all types of birthmarks.

Skin Camouflage Service
British Red Cross Association
9 Grosvenor Crescent
London
SW1X 7EJ
020-7201 5173