Understanding Vascular Birthmarks

Birthmarks are very common, with the majority being harmless, benign marks on a child. Some birthmarks, called vascular birthmarks, may need attention from a dermatologist or other pediatric specialist.

In some cases, birthmarks are fully present at birth. Other times, a birthmark takes time to develop. “When we refer to something as a ‘birthmark,’ it really means the potential for its presence is there at birth. It may be that you don't see it in its fully developed form right away, right at the moment of delivery or even in the first few days,” states Teresa Wright, MD, chief of Pediatric Dermatology at Le Bonheur Children's Hospital.

Wright shares important information for parents to help understand what vascular birthmarks are and when parents might want to seek additional care from a specialist.

What Is a Vascular Birthmark?

Vascular birthmarks are composed of blood vessel tissue that has not formed correctly. For the most part, experts don’t really understand why some children have them.

“Many babies with fair skin may be born with pink to red spots or patches on the middle of the forehead or on the upper eyelids, sometimes on the nape of the neck or the back of the scalp. You may have heard those referred to as ‘angel kisses’ when they're on the face or ‘stork bites’ when they're on the back of the neck. Those are marks that are typically harmless, and they may fade over time,” assures Wright.

Vascular birthmarks, also called a vascular anomalies, fall into two broad categories: benign or potentially problematic vascular tumors that can cause a variety of complications and vascular malformations that occur when arteries, veins and/or lymphatic channels develop abnormally.

For example, the most common type of vascular tumor is infantile hemangioma, which is a benign growth of blood vessel tissue that usually appears within the first month of life. Depending on how large they are, and where they are, these tumors can sometimes impair vital functions and need treatment. Only about half of all children with vascular anomalies require treatment.

“As you can imagine, if they are in or near the eyelid or somewhere on the face, they may cause a problem with vision or some other vital function. They can also be a real cosmetic issue,” explains Wright.

An entire category of vascular malformations exists, which are generally more fully formed at birth. They may be any combination of abnormal capillaries, veins, arteries and/or lymphatic channels. “Again, depending on the location and the extent, that's really what's going to determine whether those are going to be a problem or not,” she adds.

When Should Parents Consider a Dermatologist?

When babies come into the world, they get a full assessment from a medical team. In the subsequent weeks and months, they’ll routinely see a pediatrician for immunizations and regular check-ups.

Wright notes that most pediatricians have a good sense of whether a child should be referred to a specialist like a pediatric dermatologist. “Yet, if the parent is noticing something and they're feeling really anxious or uneasy about it, or they feel like they want an additional opinion or want a specialist to look at it, to provide more reassurance, more education, they can always ask their pediatrician for a referral.”

Vascular Anomalies Clinic: Multidisciplinary Care

The Vascular Anomalies Clinic at Le Bonheur Children's Hospital is a multidisciplinary clinic that offers a number of different specialty services, all in one location. These include professionals in radiology, interventional neurology, interventional radiology, hematology, oncology, ophthalmology and otolaryngology (ENT). The program provides coordinated care for patients with vascular anomalies, which include vascular tumors and malformations.

“We have this group of people who all come together, and then we go to the clinic where the patients are scheduled throughout the day. Whatever specialist we've decided they need to see, whether it's one of us or it's three or four of us, we see them that day. That way, they don’t have to come back for multiple visits to different clinics to see different doctors,” shares Wright. “We're all there in the same place and we can all talk about what's going on with the patient at the same time. It's a great way to get the best care to the patients and the best information and support to their families.”

Treatment spans from no intervention at all to surgery. Wright emphasizes that each patient is unique, and so is their treatment approach.

“In general, we’re going to be less aggressive about intervention for something we feel is not really bothering the child in terms of causing symptoms like pain, swelling, or limiting their ability to perform normal daily activities. This is, of course, as long as we know it's not something likely to progress and cause problems down the road if we don't intervene. We're really mindful about only treating the ones that are in fact causing a problem or are highly likely to cause a problem if we don't do something now.”