What to Do About Birthmarks

Serious birthmarks are surprisingly common. The good news: Doctors are finding new ways to treat them.

About Face

When Nicholas Barinaga was 3 days old, his parents noticed a small, salmon-colored spot on his cheek. But instead of fading, it started getting redder. At his two-week checkup, the pediatrician told them it was a hemangioma -- a type of birthmark that could continue to grow. "It got worse quickly -- within a couple of weeks, the hemangioma was 6 inches long and 3 inches wide, and it had become bright red and thick like jelly," says his mother, Corinne, of Vancouver, Washington. He took oral steroids for several months and then had a series of laser treatments over the course of a few years. The results were truly amazing. "There's still some minor color distortion on Nicholas's cheek, but most people don?t even notice it," says Barinaga.

Hemangioma: Who's at Risk?

An estimated 4 to 10 percent of infants will develop a hemangioma in the first weeks after birth. They're more likely in Caucasians, girls, twins, infants born to older moms, and preemies -- 20 percent of whom may have one. Unlike moles, which are caused by pigmentation on the skin, hemangiomas are caused by an abnormal cluster of blood vessels beneath the skin, and they're usually found on the head or neck.

Most hemangiomas are relatively small lumps of pink- or red-colored tissue, sometimes called strawberry marks. "There's a tremendous range -- from teeny tiny ones that are completely innocuous to huge ones that take up half a baby's face," says Ilona Frieden, MD, clinical professor of dermatology and pediatrics at University of California, San Francisco School of Medicine, and a leading researcher. Once hemangiomas appear, they grow rapidly for several weeks to months, and then they flatten, fade, and grow smaller over the next five to 10 years.

Since most hemangiomas eventually shrink, pediatricians have traditionally recommended simply waiting for them to go away. (In fact, this conservative approach was in part a reaction to past aggressive treatment: In the 1930s and 1940s, children with hemangiomas were often treated with radiation, and doctors later realized this could cause cancer.) However, five or 10 years can be a long time to wait -- and some children may still be left with a scar or loose, stretched skin that looks like a deflated balloon, says Dr. Frieden. That's why experts are increasingly recommending treatment or surgery for big hemangiomas sooner rather than later -- for both medical and psychological reasons.

Milton Waner, MD, a hemangioma specialist at Roosevelt Hospital, in New York City, is an outspoken advocate for earlier intervention because he thinks that having a scar is much less traumatic for a child than walking around with a large hemangioma. "Children develop their sense of self by age 3, so we want to help them look normal by then -- certainly by age 5, when they're in school," says Dr. Waner.

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