“Come here and take a look at this,” said my son’s pediatrician, as he motioned to two nurses standing outside of the room. I couldn’t believe what was happening: Roughly one week earlier, I had discovered a small, flat red line on the corner of my son’s lower lip. He was a voracious nurser, so I believed that the line was some sort of nursing blister. I thought it would go away in a few days. After a week went by and my husband and I noticed no change, I immediately made an appointment with his pediatrician.

The nurses came in, and the doctor put his gloved finger on my baby’s lip. The three of them looked at the line intensively, and my stomach turned in tight knots. My precious 4-week-old waited peacefully on the examining table, staring at me, my mother, the doctor, the Winnie the Pooh wallpaper, blissfully oblivious to what was happening around him and to his mother’s fears. “What is it?” I could barely get the words out. “It’s a hemangioma, a birthmark,” was the reply.

What Is a Birthmark?
Birthmarks are colored spots located on the skin that can either be present at birth or develop afterward. They can begin at the surface of the skin, rise above it or extend below the skin.

The exact causes of birthmarks are unknown. However, we do know that most are not inherited or genetic, nor are they caused by anything that happens during the course of a mother’s pregnancy. They can have a wide variety of color hues, and most often require little or no treatment. Depending upon a birthmark’s exact location on the body, some may interfere with a vital function such as breathing, eating, hearing or seeing. These types of birthmarks are the ones that will require early medical intervention.

According to the American Academy of Dermatology (AAD), more than 10 in 100 babies in the United States have a vascular birthmark. Vascular birthmarks are made up of blood vessels that are bunched together within the skin. They can appear flat or raised and contain a red or blue color. There are several different kinds of vascular birthmarks, with the most common being macular stains, port-wine stains and hemangiomas.

Kissed by an Angel
Macular stains tend to be the most common type of vascular birthmark for infants. The faint red marks have dual names according to their exact locations. If they are found on a baby’s forehead or eyelids, they are known as “angel kisses.” Angel kisses almost always disappear when a child reaches the age of 2. When they are found on the back or nape of a baby’s neck, they are called “stork bites.” Stork bites usually last into adulthood. Macular stains also may appear on the tip of the nose, upper lip or any other body location.

Angel kisses and stork bites can become more noticeable on a child when they are feeling either cold or hot. This type of vascular birthmark is considered harmless and usually requires little or no treatment.

Port-wine Primer
Port-wine stains are classified as vascular malformations. According to the AAD, they occur in three out of 1,000 infants per year. Port-wine stains are more common in females than in males. They appear flat, pink-red in color at birth, and they darken to a reddish-purple by several years of age. Port-wine stains are the result of an increased number of blood vessels in the upper layers of the skin. They are commonly found on the face, but can appear anywhere on an infant’s body. Unlike hemangiomas and macular stains, port-wine stains do not fade or go away. As a child grows into an adult, so does the stain. Medical complications can arise with a port-wine stain depending upon its location.

“It is very important that children with a stain in the eye area be evaluated by an optometrist and undergo an MRI,” says Dr. Steven Fishman, co-director of the Vascular Anomalies Center at Children’s Hospital in Boston, Mass. A child with a port-wine stain on or near the eye area should have their eyes checked every year for possible symptoms of glaucoma.

Even though port-wine stains will never fade, there are ways to lessen their color and appearance. Laser therapy has been successful when a child is young, since the stain has not had a significant amount of time to grow. Several laser treatments are standard, and younger patients receive fewer ones than adults. As with any treatment, there are risks involved with the use of laser therapy: Swelling and patchy, whitening of the skin are common. Doctors also have recommended the application of brand name, cover-up foundation makeup.

Harmful Hemangiomas?
Hemangiomas are the most common non-cancerous tumor in babies, occurring in 1 to 2 percent of newborns. As many as 10 to 12 percent of infants have them by the time they reach their first birthdays.

Hemangiomas are caused by numerous tiny blood vessels bunching together. According to the AAD, hemangiomas are more frequently found in newborn girls and in premature infants. All hemangiomas go through a three-stage phase. In the first stage, the hemangioma presents itself and undergoes a period of rapid growth. The second phase occurs when the hemangioma exhibits little or no change. Finally, the hemangioma enters its involution phase where it changes color from a bright red to light red, then to a gray/white and then regresses into the skin.

There are three different classifications of hemangiomas: superficial, cavernous and compound/mixed. Superficial hemangiomas are the most common, and they tend to develop around an infant’s head, neck, scalp or back. Superficial hemangiomas are more commonly referred to as “strawberry marks,” because they resemble a strawberry. Strawberry marks are made up of thick raised areas of skin that are soft to the touch and purplish-red in color. Some babies only have one, but other babies may have multiple marks.

Cavernous hemangiomas are deeply situated in the skin. They may have a blue color because the blood vessels are located deep under the skin. Because they are so deep, cavernous hemangiomas may not shrink entirely and may require surgery.

Compound/mixed hemangiomas are a combination of both superficial and cavernous hemangiomas.

Birthmark Treatments
Most vascular lesion specialists believe that treatment of hemangiomas should be on a patient-to-patient basis.

“Not every vascular lesion warrants treatment,” says Dr. Francine Blei, associate professor of pediatrics and plastic surgery at New York University Medical Center. “Ultimately, it is the decision of the parents if they wish to do these therapies.”

Most doctors prefer that the lesion undergo a natural involution. However, for children with a lesion that will not go away on its own, there are other modes of treatment. The most widely used treatment is corticosteriods, such as prednisone. Prednisone is either injected into the hemangioma or is taken by mouth in syrup form for several months.

The most common side effects of prednisone are poor growth, elevated blood sugar and elevated blood pressure, says Dr. Edwin Williams, medical director of the Williams Center for Facial Plastic Surgery in Latham, N.Y.

Laser also can be used singly and in conjunction with steroids to prevent growth or assist in the removal of a hemangioma. There are cases where surgery is the only option.

As for my son, he is now a healthy, happy and active toddler. His strawberry mark is graying considerably day by day, and his doctors believe that it will regress by itself as time goes by.

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• Talk about it!