Birthmarks are common skin markings, often present at birth or appearing shortly thereafter. Red birthmarks are vascular, involving blood vessels. While many are harmless and resolve on their own, understanding their types, origins, and when they might require medical attention is helpful.
Understanding Common Red Birthmark Types
Red birthmarks include several types. Salmon patches, also known as stork bites or angel kisses, are flat, pinkish-red marks. They often appear on a newborn’s eyelids, forehead, upper lip, or the nape of the neck. Salmon patches are more visible when an infant cries or experiences temperature changes. They typically fade within the first few years of life, though those on the neck may persist into adulthood.
Infantile hemangiomas, sometimes called strawberry marks, are raised, bright red, and bumpy. These birthmarks may be absent at birth, appearing within the first few weeks or months. They grow rapidly during the first few months, often reaching maximum size by 3 to 5 months. They then gradually shrink and fade, with many resolving completely by 5 to 10 years, though some may leave residual skin changes.
Port-wine stains, or nevus flammeus, are flat, purplish-red marks present at birth. Unlike salmon patches or hemangiomas, port-wine stains do not fade on their own. They tend to darken and may thicken or become bumpy with age. They can appear anywhere, but are most commonly found on the face, neck, scalp, arms, or legs.
The Underlying Causes of Red Birthmarks
Red birthmarks result from abnormalities in blood vessels close to the skin’s surface. For salmon patches, the red appearance is due to dilated capillaries, tiny blood vessels visible through the skin. These dilated capillaries are a normal variation.
Infantile hemangiomas result from an abnormal proliferation of endothelial cells, which line blood vessels. This overgrowth forms a dense cluster of blood vessels. The exact reason for this abnormal growth is not fully understood, but it may involve factors related to oxygen levels during fetal development.
Port-wine stains are caused by a permanent dilation of capillaries in the skin. Research indicates they can be linked to a somatic activating mutation in the GNAQ gene, occurring randomly during embryonic development. Red birthmarks are congenital, meaning they are present at birth or develop shortly after, and are not caused by anything a mother did during pregnancy.
When Medical Consultation is Recommended
While many red birthmarks are benign, certain characteristics or locations warrant medical evaluation. Birthmarks near vital areas like the eyes, nose, mouth, or airways should be assessed to ensure they do not interfere with functions. Rapid growth of a hemangioma, especially if it becomes painful, bleeds, or develops open sores, also needs prompt medical attention.
Some red birthmarks can be associated with underlying conditions. For example, large port-wine stains on the face, particularly around the eye, may be associated with Sturge-Weber syndrome, which can affect the brain and eyes. Extensive hemangiomas, especially on the face or certain other areas, might be linked to PHACES syndrome. Any birthmark with an unusual appearance, unexpected changes, or discomfort should be reviewed by a healthcare professional.
Approaches to Management and Treatment
Management of red birthmarks depends on their type, location, size, and potential impact. Many, like salmon patches and most infantile hemangiomas, do not require active treatment. They are observed as they naturally fade or regress over time. This watch-and-wait approach is often sufficient given their benign nature.
For infantile hemangiomas posing functional risks, causing ulceration, or being cosmetically significant, medical interventions are available. Oral propranolol, a beta-blocker, is a primary treatment. It constricts blood vessels and inhibits hemangioma cell growth, reducing size and color. Topical timolol, another beta-blocker, may be used for smaller, superficial hemangiomas.
Port-wine stains, which do not resolve on their own, are primarily treated with pulsed dye laser therapy. This laser targets blood vessels, causing them to shrink and lighten the color. Multiple sessions are usually necessary for optimal results, and early intervention can lead to better outcomes. Surgical removal is a less common option, generally reserved for birthmarks not responding to other treatments or causing significant functional issues, though it may result in scarring.