Ask the Dermatologist: Birthmarks

When you’re a new parent, worrying becomes your default. You google things like infant acne and cradle cap, keep detailed logs on your babe’s feedings and diapers. Naturally, “birth marks” are cause for new parent concern; what are they and will they ever go away? We asked Dr. Kara Shah of Kenwood Dermatology to brief us on birthmarks, as one of our fellow Cincinnati Parents had this question:

My baby was born with a strawberry mark on her cheek. What is this, and is it something I should be concerned about?

Infantile hemangiomas are very common birthmarks. Hemangiomas are noted in 5-10% of infants. They are sometimes referred to as “strawberry birthmarks” due to the common resemblance to a strawberry: red and raised from the surface of the skin.

While alarming, infantile hemangiomas are benign skin tumors that are formed by immature blood vessels. While there are several theories as to how and why they develop, their exact cause remains unknown. They are more common in girls, in white infants, in premature infants, and in infants whose mothers experienced prenatal complications such as placenta previa and preeclampsia.

Most infantile hemangiomas are not present at birth, although some may be noted as a bruise-like area of skin. Within the first few days to weeks of life, typical infantile hemangiomas appear as a red, flat area of skin (superficial hemangioma), as a skin-colored to bluish growth under the skin (deep hemangioma), or as a combination of both (mixed hemangioma). Over the first months of life, most hemangiomas will increase in size; most growth occurs during the first 3-5 months of life, though additional growth may occur until one year of age of later. Around one year of age, most hemangiomas begin to slowly involute or disappear over several years’ time; after involution, many hemangiomas leave little evidence behind. After 7-8 years of age, little additional spontaneous improvement is expected. If any residual skin changes are noted, they tend to appear as areas of broken blood vessels and/or changes in skin texture.

Most hemangiomas remain less than 2-3 inches in size, are of no medical concern, and disappear without the need for any treatment. Less commonly, an infantile hemangioma may develop a complication such as ulceration, bleeding, or obstruction of a vital structure such as they eye or may result in significant deformity or risk for cosmetic disfigurement. In these cases, early diagnosis and intervention is very important. Although treatment is individualized based on the age of the child, the size and location of the hemangioma, and the presence of any other medical issues, treatment options include the use of topical or oral medications, laser therapy, and surgery. Very rarely, the presence of one or more hemangiomas may indicate the possibility of other medical concerns or syndromes.

The most commonly used medications to treat hemangiomas that require intervention are oral propranolol and topical timolol solution. Although the exact mechanism of action with regards to hemangiomas remains controversial, these medications have been shown to be effective in limiting further growth of treated hemangiomas and of increasing the rate at which treated hemangiomas involute. Close monitoring of infants treated with these medications, in particular with oral propranolol, is important due to the risk of medication side effects. With regards to hemangiomas in older children that have left residual broken blood vessels behind after involution, treatment with pulsed dye laser can help to remove residual redness.

Parents of children with a hemangioma, take note; most hemangiomas do not require intervention and will disappear with time. If you have any concerns about your child’s hemangioma, evaluation by a dermatologist is recommended in order to review expectations and to discuss whether treatment is needed.

Ask the DermatologistDr. Shah was previously the Director of Pediatric Dermatology at Cincinnati Children’s Hospital, and prior to relocating to Cincinnati, she was the Clinical Director of Pediatric Dermatology at the Children’s Hospital of Philadelphia. Motivated to provide more personalized and specialized dermatology services, she started Kenwood Dermatology in 2016, where she focuses on providing expert skin care to children, adolescents and young adults. While she enjoys caring for patients with a variety of skin concerns, her special interests include hemangioma and other birthmarks, melanocytic nevi (moles) and melanoma, psoriasis, acne, atopic dermatitis/eczema, hair and nail disorders, and genetic skin diseases.

Among her many achievements, she was recognized by Cincinnati Magazine as a Top Doctor in 2016.

Dr. Shah serves on the medical advisory boards for the Foundation for Ichthyosis and Related Skin Types and the National Psoriasis Foundation. She is also on the Scientific Advisory Council for Naevus Global and is a Councilor for the International Society for Pediatric Wound Care. Dr. Shah is board-certified in General Pediatrics, General Dermatology, and Pediatric Dermatology.

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