Every parent who welcomes a new baby is always waiting for the birth of the baby with a longing mood, but once they find the strange birthmarks on the newborn baby, they are inevitably apprehensive and full of questions. How do birthmarks occur? Will the birthmark affect the baby’s health? Do birthmarks need to be treated? How to treat them?
In fact, most of the birthmarks on babies will disappear gradually as they grow up, so parents do not need to worry too much. However, if you find that the birthmarks on your baby are a bit strange, you should consult a professional dermatologist to make an early and appropriate diagnosis and treatment.
Birthmarks are generally caused by skin pigment abnormalities or skin vascular abnormalities, mainly including “spots”, “moles”, and “red birthmarks”. We will introduce some common birthmarks.
A. Spot
1.Mongolian spots which can disappear naturally
Mongolian spot is the most common birthmark in newborns, especially in yellow people, often appearing on the waist, buttocks and back of babies, which is a light grayish-blue or dark blue patch, mostly occurring in a single piece, round or or oval. Mongolian spots are caused by the delayed disappearance of some melanocytes in the dermis during embryonic development. Although the chance of their occurrence is quite high, they will almost always fade away naturally as babies grow up, so there is no need to worry.
2.Coffee milk spots that never disappear
Coffee milk spot, as the name suggests, is because the color of this birthmark is light brown, somewhat like the color of coffee plus creamer. The diameter is generally 0.5~5cm, oval or fusiform, and the boundary between the spots is clearly defined. If only a few coffee milk spots are present, there is usually no adverse effect; however, if more than six spots are present, and each spot is larger than 1.5 cm in diameter, the chance of complicating neurofibromatosis increases significantly. Neurofibromatosis is a congenital disease that affects both the skin and the nervous system, and may affect the baby’s intellectual development. If it affects the beauty, Q-switched laser treatment can be used.
3.Nevus of Ota that seriously affects the beauty
Nevus of Ota is called “mole”, but its pathology is the same as Mongolian spot, so it is introduced in “spot”. Nevus of Ota is a pigmented birthmark characterized by greenish-brown spots around the eyes, which is common among Mongolian people in East Asia (sometimes it does not always appear at birth), and is a disease of increased melanin in the dermis. It is a disease that affects Yang Zhi, the hero of “Water Margin” and known as the “green-faced beast”, and is congenital in 50% of cases, with some patients having a delayed onset, which can occur after the age of 35. It appears as blue, brown, black or mixed-colored patches or spots, distributed unilaterally on the face, or occasionally bilaterally, with some spreading to the conjunctiva and sclera of the eye. In some patients, the lesions have the tendency to increase slowly. Nevus of Ota has no hereditary tendency and generally does not become malignant. However, once nevus of Ota occurs, it will not fade away for a lifetime, which seriously affects the beauty. Q-switched laser treatment can be given after the nevus of Ota rash is stabilized with relatively small side effects. This method destroys melanocytes through relative selective photothermal effect, and the final result of treatment is more ideal with higher success rate, no obvious scar, and no obvious change of skin texture.
Second, moles
1. Congenital nevus with hair growth – hairy nevus
This is a nevus that exists when the baby is born. They vary in shape and size, and can invade the whole back, neck or limbs. Smaller ones are usually 0.6 to 2 cm in diameter and are mostly dark in color and have thick black hairs. These moles will increase in size as the baby grows and have a certain tendency to become malignant. If the number of moles is small and the area is not large, they can be removed in stages to achieve good cosmetic results; however, if the number is too large or the scope of moles is too large to be removed surgically, they need to be supplemented with psychological treatment and regular follow-ups.
2.The most common benign skin tumor – pigmented nevus
Pigmented nevus is a benign tumor of skin composed of melanin-containing nevus cells. They occur on the face, neck and other parts of the body, and most of them appear in infancy. Most pigmented nevi grow slowly or persist unchanged for years, but once present, they rarely subside. The pigmentation may vary from tan or black, and most of them are small, punctiform moles, and rarely appear in large areas. Most pigmented nevi are benign and do not need to be overly concerned. However, very few of them can become malignant melanoma. For pigmented nevus located in palmoplantar and genitalia or its color deepens, area increases, breaks down and bleeds, and satellite skin lesions appear around, early surgery should be performed to avoid malignant transformation.
4.Sebaceous nevus and wart-like nevus
Sebaceous nevus is a kind of benign skin tumor composed of sebaceous glands. It is more common, mostly develops at birth or soon after birth, and usually occurs on the scalp. It appears as a raised yellowish nodule. In adolescence, the damage thickens and enlarges, and the yellow color becomes obvious. To prevent complications with other skin tumors, they should be surgically and completely removed, or treated with electrocautery or laser. It is usually best to treat before puberty.
Verrucous nevus is a benign skin tumor due to abnormal epidermal development. It usually develops in infancy and early childhood. They appear as dense pale brown papules arranged in a linear pattern as warty growths. The generalized form of the disease is often complicated by central system disorders such as epilepsy and mental retardation. The damage can be removed by freezing, laser or surgery if the damage is small and limited.
Red birthmark
Hemangioma, commonly known as “red birthmark”, is the most common benign tumor of blood vessels in infants. It is due to the detachment of angioblasts from the developing vascular network during embryonic development, which remains and overgrows in other parts. It is mostly detected at birth or within a few months after birth. It grows rapidly and has a serious aesthetic impact. The traditional classification of hemangioma and vascular malformation is collectively called “hemangioma”. In 1982, the biological classification was introduced, i.e., congenital cutaneous vascular disorders are classified into two categories: hemangioma and vascular malformation, based on the proliferative properties of vascular endothelial cells and clinical manifestations. Hemangiomas, also known as infantile hemangiomas (mostly strawberry hemangiomas in the traditional classification), are characterized by vascular endothelial cell proliferation, have rapid growth in the early postnatal period of pediatric life, and most of them can begin to regress spontaneously after six months and are effective for hormonal treatment. Vascular malformations have normal endothelial cells and are characterized by abnormal expansion of various blood vessels (such as capillaries, veins or arteries), which not only do not subside spontaneously but also gradually expand and are ineffective for hormone therapy. The following 1~3 belong to hemangioma, and 4 (erythema nodosum) belongs to vascular malformation.
1.Capillary hemangioma
Also known as strawberry hemangioma, it appears at birth or during the neonatal period and is usually found on the head, face and neck, and is not higher than the skin. After 2-6 months after birth, it grows rapidly and forms a soft strawberry-shaped mass above the skin surface. Later, after a resting period of 1 to 2 months, the tumor growth is slow or stops. Most capillary hemangiomas enter the regression period in 8-12 months after birth, and 30~50% of the children can generally regress on their own at the age of 3~5 years.
2.Cavernous hemangioma
Preferably occurring in the skin of head and face, it may involve oral mucosa or bone, liver, etc. Skin cavernous hemangioma is a soft subcutaneous mass with a tendency to persist and increase in size.
3.Mixed type hemangioma
It is a mixture of two types of hemangioma, but one type is the main type.
4. Vivid nevus (wine spot)
Prevalent on the head, face and neck, dark red irregularly colored spots, not higher than the skin, easy to fade with finger pressure. It can increase in size as the body grows up, and mostly exists for life.
Most hemangiomas can fade naturally. Generally speaking, the natural process of hemangioma goes through three periods: growth, quiescence, and regression. According to the literature, about 50-65% of hemangiomas can regress spontaneously by the age of 5. Although most of the hemangiomas can subside naturally, the rapid growth and outward expansion of hemangiomas in the early stage and the rich blood supply lead to local tissue hypertrophy and even local leftover sagging soft tissues, and the hemangiomas are not consistent with normal skin color after subside, especially the local protrusion and deformation in exposed parts such as face, which affects the appearance and may affect the psychological health of children. In addition, the syndrome caused by giant hemangioma. Shortened platelet survival. Massive reduction of platelets can cause acute bleeding (gastrointestinal tract, pleura, peritoneum or central nervous system). The mortality rate is as high as 50% and should be treated aggressively. Therefore, early and appropriate interventional treatment is currently advocated by the medical community to control the rapid growth of hemangioma and to stabilize it into the regression phase as early as possible. In the past, due to the lack of understanding of the natural evolution of hemangioma, treatments such as freezing, radiation, sclerotherapy, and hormones were often used. Long-term follow-up confirms that the various treatments mentioned above bring about many sequelae, as well as a recurrence rate of about 30%.
Of course, most of the red birthmarks that will not fade should be vascular malformations. This is the case for the clinically seen erythema nodosum, which is characterized by slow growth with age and never fading. This vascular malformation is currently advocated to be treated aggressively. In order to avoid the increasing area and volume, which will make the later treatment more difficult. In conclusion, the treatment of birthmarks should depend on their type, size, location and other specific circumstances.