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Vascular Birthmarks

It is common for infants to have what are commonly called "birthmarks" these are present at birth or develop by the time the child is a few weeks old. They vary in color and can be pink, red, brown, tan, or blue. More than ten percent of babies have (red) vascular birthmarks. These are formed by increased number of blood vessels in the skin. They can be raised or flat, red, pink, or a bluish color.

It is unknown what causes birthmarks. However, vascular birthmarks are neither inherited, nor caused by anything that occurred during pregnancy.

There are different kinds of vascular birthmarks. Sometimes the birthmark must be watched for several weeks or months before the type can be identified. The most common types of vascular birthmarks are macular (flat) stains, port wine stains, and hemangiomas. There are some other forms of vascular birthmarks that are very rare.

This is the most common form of vascular birthmark that your physician may identify; it is called a macular stain. They are also called "angel's kisses," if they are found on the eyelids, forehead, upper lip, or tip of nose. If they are on the back of the neck, they are commonly referred to as a "stork bite.” Macular stains are generally flat, faint, pink, or mild red. While stork bites usually persist into adulthood, angel's kisses almost always go away by age two. These are harmless birthmarks requiring no treatment.

The port-wine stain is another type of vascular birthmark that occurs in 3 in 1,000 infants. Port-wine stains appear at birth. They can have a purplish discoloration, red, pink, and are flat. Unlike hemangiomas, a port-wine stain grows as the child does. In time, a port-wine stain can thicken and possibly develop small ridges or bumps. Port-wine stains are permanent.

Dermatologists prefer to use the term hemangioma to refer to a common type of vascular birthmark. These marks do not usually appear immediately at birth, but become visible within the first few weeks of life. Hemangiomas are usually divided into two types: superficial (used to be called "strawberry" hemangiomas), and deep.

A superficial hemangioma is raised and bright red because the abnormal blood vessels are very close to the surface of the skin. Deep hemangiomas normally have a bluish-purple color due to the abnormal vessels are deep under the skin (similar to the way varicose veins look blue). Hemangiomas are most commonly found in females, normally on the neck, and head and more common in premature babies. They can be anywhere on the body.

Usually, a baby will have only one hemangioma, but sometimes there will be two or three. In very rare cases, an infant may have many or even some internally. Unlike other vascular birthmarks, hemangiomas normally grow rapidly. The growth normally begins during the first six weeks and continues up until the child is about a year old. After the first year, most hemangiomas will stop growing. They then begin to turn white and slowly shrink. Nearly half of hemangiomas (50%) are flat by age five. Nine out of ten (90%) are flat by age nine. Many will completely go away, but often, a faint mark is left. It is impossible to gage how large a hemangioma will be, or know if it will disappear completely.

Sometimes, a hemangioma that is rapidly shrinking or growing can cause an ulcer or open sore. These sores are often painful, and can become infected. It's very important to see your dermatologist and keep this ulcer clean and covered with antibiotic ointment and/or a dressing.

A hemangioma located over the genitals or rectum, near an eye, nose, or mouth, can cause special problems. These hemangiomas should be watched closely by your dermatologist who will decide if further treatment is necessary.

Parents are often concerned that a hemangioma will bleed. These birthmarks do look as if they could bleed easily. However, this typically isn't an issue due to the fact the blood vessels are extremely tiny capillaries. Normally bleeding only occurs after injury. If the hemangioma begins bleeding, it should be treated like any other injury by cleaning the area with soap and water or hydrogen peroxide, and applying a gauze bandage. Apply firm, but not tight, pressure on the area for five to ten minutes to stop bleeding.

It's very important that a baby with a vascular birthmark be examined by a dermatologist as early as possible so that a correct diagnosis can be made and the possible need for treatment discussed. It's not always easy for parents to watch a hemangioma grow, or wait for it to disappear without doing anything. However, most hemangiomas do not require treatment. They eventually shrink by themselves, leaving very few signs.

There are several different types of treatments for hemangiomas. Most of the time, your dermatologist will choose to watch the lesion. Other possibilities will be considered only under certain circumstances. No treatment is absolutely safe and effective. The potential benefits of treatment must be weighed against the possible risks.

The most widely used treatment for rapidly growing hemangiomas is corticosteroid medication. This can be applied topically, injected into the hemangioma or given by mouth. Long-term or repeated treatments may be necessary. Topical imiquimod (Aldara) has been successfully used in some cases. Newly evolving treatments may include the application or oral ingestion of medications called beta-blockers, traditionally used in adults with high-blood pressure. This treatment seems very promising and is expected to become the standard of care soon.

Lasers may be used to stop the growth of hemangiomas and remove superficial hemangiomas. Lasers can be used to treat Hemangiomas that have sores that will not heal.


We put academic qualifications, many years of combined experience, and training in a variety of special interest areas to work for your healthy, radiant skin. Our providers – Drs. Schachter, Hanna, Curtis, Abdulla, Pollack, and Taradash – welcome new patients for treatment at the Dermatology on Bloor practice on Park Road in Toronto. Our team is here to serve your needs

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