Birth marks are common in the newborn period and depending on their characteristics can be observed for spontaneous resolution or mandate emergent medical attention. These marks often cause a lot of concern for parents who understandably worry about their newborn, the cosmetic effect and the clinical course.
What are these pinkish marks on the baby’s skin, Doc? Will they go away? What can be done to make it go away?
Many different skin lesions are possible in the newborn period, some are present at birth and others develop after birth. The scope of this post is not to describe every skin lesion possible in the newborn period. We apologize for the gross simplification and will concern ourselves with two types of skin malformations commonly seen in the newborn period. These are hemangiomas and vascular malformations.
The best example of a vascular malformation is the “Stork Bite”, also called a “Salmon Patch”. The medical terminology used is Nevus Simplex. These occur as a result of variation and flaccidity in the tiny blood vessels beneath the affected area of skin called capillaries, they are superficial and pale- pinkish in appearance as a result and very closely similar to salmon fish color hence, the common name. They are commonly seen in 30% to 40% of newborns especially around the neck, hairline posteriorly, forehead, area between the eyebrows and along the lower back. These marks require no treatment and usually fades within the first year of life. Crying episodes, changes in environmental temperature and, breath holding are some of the changes that can briefly make these marks more obvious. Salmon patches on the back of the neck and head usually persist and are often covered by hair.
Hemangiomas are seen in up to 10% of newborn. Hemangiomas could be present at birth or appear shortly after birth. Experts currently believe the to-be affected skin areas are determined early in the first trimester (1st 13 weeks) of pregnancy. Hemangiomas grow in volume as a result of the excessive increase in blood vessel formation. This growth is most rapid in the first few weeks of life and results in the formation of bright red lesions with some elevation above the surrounding skin and range in size from being smaller than a dime to lesions several inches across in size. Some hemangiomas are located deep in the skin and changes in body position can affect their color intensity as they fill and empty with blood with gravity. The potential body surface area involved, appearance and association with other medical conditions vary considerably. They usually reach 80% of the maximum size at about 3-6 months of life and a marked cessation of growth follows this period. This is then followed by a slow process of involution where the blood vessels are gradually converted to fibrous type tissue. The lesions undergo a slow regression with about 25% of lesions resolving between ages 2-3 and 75% resolving between ages 5 and 6. Even after lesion resolution, residual skin changes with redundant post inflammatory changes are not uncommon. All hemangiomas do not follow the course above and complications like bleeding, infection or the disturbance of adjacent body organ and function are possible. These cases are managed with specialists. Different treatment options including laser therapy, steroids, propranolol, embolization are being used. A current study is underway in Europe and the USA to learn more about the safety profile and the exciting therapeutic advantages promised by propranolol and related medications which were traditionally used for other purposes in the past.
Primary care physicians have long waiting times, however we will strive to put parents of these patients ahead of the line, the anxiety and the stress imposed by lesions on the skin of the newborn cannot be stressed enough and needs to be addressed promptly.
This information is for educational purposes only and not a substitute for professional medical care or advice. Always follow your healthcare provider’s instructions.