Childhood Diseases

Question
Posted by: Gerhard | 2007/03/14

Q.

strawberry mark / birthmark

Hi, my daughter is 6 months old and has a strawberry mark on her forehead in her hairline. It has grown to about 1cm. We live in Namibia and dont have such a wide variety of Doctors to choose from. Our paediatician said that we should not worry about it and that it should disapear, however another Dr (a dermatologist) said that we should get it removed asap because it could become a problem. He suggested that we concider laser treatment. Then somebody said that if they remove it with laser, her hair will not grow on that spot anymore. Being in her hairline this could be a problem. Please could you give some advice.

Expert's Reply

A.

Paediatrician

It is very difficult to give you advice without being able to see the strawberry mark. In most cases these marks disappear by themselves as mentioned by your paediatrician.You say that the mark has increased in size which can happen at times before it then starts getting smaller. In view of your dermatologist's concern your best option is to get a second opinion and I would recommend that you ask for a referral to Dr Ean Smit, Dermatologist in Panorama, Tel 021 9302973

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

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user comments

C.

Posted by: S | 2007/03/14

Can my baby's birthmark be removed?
It depends. Some of the conditions mentioned above (like a hemangioma pushing on the eye) might require removal. If a birthmark isn't disfiguring or causing physical problems, your baby's doctor may suggest that it's best to leave it alone.

Of course, the sight of a large hemangioma on your child's face can be distressing, and it's understandable if you want to do something about it now. But because most of these birthmarks will fade by the time your child's ready for school, your doctor may not recommend any special treatment.

Some experts have challenged this wait-and-see approach, arguing that early intervention to treat certain birthmarks can be helpful because enough of them don't go away on their own. So you may want to get more than one opinion about treatment.

Treatment options
Depending on the birthmark, treatment options include surgery, laser therapy, and topical, oral, or injected steroids. Orlow says that almost all surgical birthmark-removal treatments can cause some scarring.

While in the past port-wine stains could not be treated, the introduction of the first pulsed-dye laser 20 years ago revolutionized the management of these birthmarks, especially on the face.

Reply to S
Posted by: S | 2007/03/14

Hi Gerhard

My daughter also had what they call stork bites, she is almost a year old and it has faded a lot. It also grew initally as her head got bigger. I will suggest that you wait until you are in SA again and then take her to a specialist. Chances are that if you wait, it will fade in time and not have to put your daughter through all of that. If you need more information or pics to make sure that you have indentified her birthmark correctly just go to Google and type in the word birthmarks. It will give you a range of websites to choose from. But don't worry, I am sure it will fade. Here's some info on birthmarks in the meantime.

What are birthmarks?
Birthmarks are areas of discolored skin that are on a baby's body at birth or that show up within a few months after delivery. Over 80 percent of babies have some kind of birthmark. Some endure for life, while others fade away over time.

Most birthmarks fall into one of two categories: vascular or pigmented. Vascular birthmarks are caused by blood vessels that have accumulated below the surface of the skin. They range in color from pink to red to bluish, depending on the depth of the blood vessels. Pigmented birthmarks — usually brown, gray, bluish, or black — result from an abnormal development of pigment cells.

What do they look like and which ones are most common?
Birthmarks come in a wide range of shapes, sizes, and colors, and they can show up anywhere on the body. Some birthmarks are referred to as nevi ("nevus" is the singular). The most common varieties are:
• "Stork bites," "angel kisses," salmon patches, and vascular stains: Blotchy pink or purple flat marks that are formed by dilated capillaries near the surface of the skin. This is the most common type of birthmark, with up to 70 percent of babies having one or more.

These birthmarks can become more noticeable when your baby cries or when there's a change in temperature. The ones on the back of the neck, called stork bites, usually last into adulthood. The ones on the forehead or eyelids, called angel kisses, usually go away by age 2.

• Café au lait spots: Tan or light brown flat patches that sometimes appear in multiples. Between 20 and 50 percent of newborns have one or two of these pigmented birthmarks. They usually fade or get smaller as a child grows, although they may darken with sun exposure.

• Moles: Clusters of pigment-making skin cells. Moles vary in size and may be flat or raised, black or brown, hairy or not. Many moles don't show up until a child is a few years old.

Moles that are present at birth are called congenital nevi, or birthmark moles, and about 1 percent of babies have them. These moles often start out flat and become slightly larger and more raised.

• Bluish or grayish Mongolian spots: Large, flat areas of extra pigment on the lower back or buttocks that are most common in babies with dark skin: 95 to 100 percent of Asian, 90 to 95 percent of East African, 85 to 90 percent of Native American, and 50 to 70 percent of Hispanic babies have them. (Only 1 to 10 percent of Caucasian babies do.) Mongolian spots usually fade by school age, although they may never disappear altogether.

• Port-wine stains, or nevus flammeus: Present at birth, these vascular birthmarks range from pale pink to dark purple and can appear anywhere on the body, although they show up most often on the face or head. About 1 in 300 infants is born with a port-wine stain.

Light port-wine stains might fade, but most endure and get bigger as the child grows. Sometimes port-wine stains can thicken and darken (the birthmark on former Russian president Mikhail Gorbachev's head is one example). They can also form cobblestones, or small lumps, on the surface of the skin over the course of decades.

• Hemangioma: This term is used to describe a variety of blood-vessel growths. These flat or raised lesions can be large and disfiguring or small and not very noticeable.

Hemangiomas affect about 2 to 5 percent of babies and are more common in girls, preemies, and twins. Twenty percent of children who have hemangiomas have more than one.

Hemangiomas occur mostly on the head and neck, and, unlike other birthmarks, they can grow rapidly. They usually show up during the first six weeks of life — only 30 percent are visible at birth — and grow for about a year, usually getting no bigger than 2 or 3 inches.

Then, without treatment, they usually stop growing and begin to turn white and shrink. This reversal process can take three to ten years. While many hemangiomas leave normal-looking skin in their wake, others can cause permanent skin changes.

One type of hemangioma, a superficial hemangioma (formerly called a strawberry hemangioma), appears on about 2 to 5 percent of babies. This raised pink-red mark tends to grow and then disappear — half are flat by age 5, and nine out of ten are flat by age 9.

A deeper hemangioma (formerly called a cavernous hemangioma) appears as a lumpy bluish-red mass. It grows quickly in the first six months and is usually gone by the time a child reaches his teens. Such hemangiomas are bluish in color because the abnormal vessels are deeper than those in the superficial hemangioma.

Do birthmarks require medical attention?
According to dermatologist Seth Orlow, director of pediatric dermatology at New York University School of Medicine, most birthmarks are harmless, and many go away on their own in the first few years of life.

There are a few exceptions, though. In fact, 40,000 U.S. children a year have birthmarks that need medical attention. So it's important to have your child's healthcare provider take a look at all of your child's birthmarks. Potential problems include:

• Port-wine stains near the eye and cheek are sometimes associated with vision problems like glaucoma, or with seizures and developmental delay. (This is known as Sturge-Weber syndrome.)

• Large hemangiomas, depending on where they're located, can interfere with eating, seeing, or breathing. Hemangiomas can sometimes grow internally, threatening the health of an organ. Others can be cosmetically disfiguring.

• Birthmarks on the lower spine may extend beneath the skin and affect the nerves and blood flow to the spinal cord.

• Groups of six or more café au lait spots may be a sign of a genetic disorder called neurofibromatosis type 1 (NF-1). Children with NF-1 usually have the spots at birth or by age 2, although the number may increase in childhood and occasionally later in life. About 50 percent of people with NF-1 also have learning disabilities.

• Certain especially large moles that are present at birth have an increased risk of eventually becoming cancerous.

• Some prominent or disfiguring birthmarks can become psychologically damaging to a child over time.

Reply to S

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