Most birthmarks are harmless and some disappear without treatment.
Some birthmarks may need to be treated for medical reasons, while some people may choose to have a birthmark treated for cosmetic reasons.
Haemangiomas sometimes disappear without treatment, but they often don't change until your child is two years old.
Haemangiomas will sometimes disappear by the time a child reaches five years of age. In other cases, they may last until a child is 12.
Plastic surgery may be an option if a haemangioma has left the skin deformed or stretched. The aim of surgery will be to improve the appearance of the distorted skin.
If the haemangioma has formed an ulcer, extra measures may need to be taken to prevent infection, and surgery or laser treatment may be offered.
Read more about the complications of birthmarks.
Large or complicated haemangiomas
Some haemangiomas may cause complications that will need treatment.
A haemangioma near your child's eye, nose or mouth may cause vision, breathing or feeding problems.
Haemangiomas on the lip or around the nappy area are more likely to form ulcers that can sometimes bleed and be painful.
The exact treatment will depend on where and how severe the haemangioma is. Most haemangiomas can be effectively treated with medicine, such as propranolol which is given by mouth as a liquid. This will shrink the birthmark.
If propranolol doesn't work, other medicines can be used, such as steroids or vincristine. Surgery is rarely necessary.
If your child has breathing difficulties caused by a haemangioma in their airway, they may need laser treatment.
This will usually be carried out during an examination of their airway using a small telescope called an endoscope. The procedure is known as microlaryngoscopy and bronchoscopy. They may also be given propranolol (see below).
You can read more about microlaryngoscopy and bronchoscopy on the Great Ormond Street Hospital for Children (GOSH) website.
Occasionally, a child with a haemangioma in their airway may need to have a temporary tracheostomy (an artificial opening in the windpipe) to improve their breathing.
Medication may be recommended if the haemangioma is complicated or large. This is usually a beta-blocker called propranolol. The full side effects of using propranolol to treat a haemangioma are still being monitored.
Beta-blockers work by blocking the release of noradrenaline in certain parts of the body. Noradrenaline is a chemical released by nerves when they're stimulated. The noradrenaline passes messages to other parts of the body, such as the muscles, blood vessels and heart.
It's thought that propranolol helps narrow the blood vessels, reducing the amount of blood flowing through them. This makes the haemangioma lighter in colour and softer. The cells that cause the haemangioma to grow are also affected so that it gets smaller.
Haemangiomas often leave a patch of stretched and thinned skin, with a small amount of swelling of the tissues under the skin. This is barely noticeable in most areas.
However, in areas such as the nose, lips, ears and cheek, these small changes can be unsightly. In these areas, treatment with propranalol may be considered during the first few weeks of life, immediately after the haemangioma has been diagnosed, so that the long-term appearance can be improved.
Monitoring internal haemangiomas
If your child has a haemangioma in an internal organ, they may need an ultrasound scan or magnetic resonance imaging (MRI) scan to confirm its location and size. MRI scans use a magnetic field and radio waves to produce detailed pictures of the inside of the body.
Capillary malformation (port wine stains)
Capillary malformation (port wine stains) are permanent, but treatment helps fade the mark, making it less noticeable. You can also disguise it using cosmetics.
Laser treatment is the only treatment for a port wine stain. It lightens the affected area of skin. Laser treatment often works better in younger children because in adults a port wine stain may become bumpy and raised after a number of years.
The most common type of laser treatment is pulsed dye laser treatment. The laser passes through a fibreoptic cable. On the end of the cable is a device that looks like a pen. It's gently held against the surface of your child's skin and a button is pressed, which sends a beam of light to the skin.
The light goes less than 1mm into the skin. It's absorbed by the blood vessel just beneath the surface, causing it to heat up. The heat damages the blood vessel, which creates a bruise that will fade within a week or two.
During or after treatment, your child's skin will be cooled to reduce discomfort. A jet of cold air may be blown onto the skin during treatment.
Some of the possible side effects of laser treatment include:
- bruising – after some types of laser treatment, it's normal for the mark on the skin to look worse because of bruising, but this will fade after one to two weeks
- pain – the laser stings, so most children have laser treatment under general anaesthetic (where they're put to sleep), but some children can tolerate treatment with the help of a local anaesthetic cream that numbs the skin; a cold gel pad may also be put on the area before treatment to minimise any discomfort
- increased sensitivity to sunlight – your child's skin will be very prone to sunburn for up to six months after laser treatment
Between three and 30 treatment sessions may be needed at intervals of six to eight weeks.
How effective the treatment is will depend on how prominent and dark the affected area is. The best results are often seen in marks that are already smaller and lighter.
You can get a prescription for a special type of camouflage make-up that covers up the birthmark.
The charity Changing Faces now runs the skin camouflage service previously run by the Red Cross. You can book an appointment with a trained volunteer, who can teach you to apply the make-up.
You can also read more about skin camouflage on the websites of the British Association of Skin Camouflage and the Skin Camouflage Network.
Congenital melanocytic naevi (CMN)
As congenital melanocytic naevi (CMN) can affect a person's appearance, surgery may be considered. However, surgery will leave scarring and may not be possible if the affected area is very large.
Surgery involves removing the birthmark and stitching together the edges of skin. If the area is large, a skin graft may be needed. This involves taking skin from another part of the body and using it to cover the wound.