What causes birthmarks? What to know about the different types of birthmarks (2024)

What are birthmarks?

Birthmarks are areas of discolored and sometimes raised skin that are on a child's body at birth or that show up within a few months after delivery. Over 80 percent of babies have some kind of birthmark. Some last for life, while others fade away.

Most birthmarks fall into one of two categories: vascular or pigmented. Vascular birthmarks are caused by extra blood vessels close to the surface of the skin. They range in color from pink to red to bluish, depending on the depth of the blood vessels and your baby's skin color. Pigmented birthmarks – usually brown, gray, bluish, or black – typically result from the development of extra pigment cells.

If your baby has a birthmark, don't worry. Most birthmarks are harmless. However, get the birthmark checked out by a dermatologist to make sure it won't grow and cause problems for your baby and that it's not a sign of skin disease.

Does everyone have a birthmark?

Not everyone has a birthmark, but birthmarks are extremely common in newborns. Vascular-type birthmarks called "stork bites," for example, show up on as many as 80 percent of babies. Most Asian and Black babies and almost half of Hispanic babies are born with a type of pigmented birth mark called dermal melanocytosis (previously but no longer referred to as "Mongolian spots") that often fade by the toddler years.

Other birthmarks are slightly less common. Between 1 and 3 percent of newborns have moles at birth or within the first year of life. Up to 5 percent have benign growths called infantile hemangiomas. And about 2 in 10,000 children are born with a rare tangle of veins in the skin called venous malformations.

Are there different types of birthmarks?

Yes. Birthmarks come in a wide range of shapes, sizes, and colors, and they can show up anywhere on the body. Some birthmarks are referred to by the medical term nevi ("nevus" is the singular). The most common varieties are:

• Nevus simplex, "stork bites," "angel kisses," "salmon patch" marks: Blotchy pink, red or purple flat marks that are formed by dilated capillaries near the surface of the skin. This is the most common type of birthmark, with up to 80 percent of babies having one or more. These birthmarks can become more noticeable when your baby cries or when there's a change in temperature. They're typically located somewhere on the face or back of the neck. The ones on the back of the neck are often called stork bites. Those between the eyebrows are sometimes called angel kisses. Nevus simplex on the face usually disappear by the time your baby is a toddler, although stork bites may remain.
• Café au lait spots: Tan or light brown flat patches that sometimes appear in multiples. Between 20 and 30 percent of people have these pigmented birthmarks. They usually fade or get smaller as a child grows, although they may darken with sun exposure. Most are harmless, but multiple or very large café au lait spots may be a sign of disease, so ask a dermatologist or pediatrician to check them out.
• Moles: Clusters of pigment-making skin cells. Moles vary in size and may be flat or raised, black or brown, red or pink, hairy or not. Some can appear flesh-colored at first, but darken and get bigger over time. Many moles don't show up until a child is a few years old. Between 1 and 3 percent of babies have moles that are present at birth, which are called congenital nevi, or birthmark moles. These moles often start out flat and become slightly larger and more raised. Most moles are harmless, but it's important to look out for changes in color, shape and size. A child born with multiple moles may need an evaluation for a rare but serious condition.
• Dermal melanocytosis: Large, flat areas of extra pigment, usually on the lower back or buttock. They may be a mix of colors, including blue, gray, brown or black. They are most common in babies with dark skin: 85 percent of Asian, 96 percent of Blacks, 90 percent of Native American, and 50 to 46 percent of Hispanic babies have them. (Fewer than 10 percent of Caucasian babies do.) Although sometimes referred to as "Mongolian spots," the more appropriate, medical term is congenital dermal melanocytosis. The marks usually fade by school age, although they may never disappear.
• Port-wine stain birthmarks, or nevus flammeus: Present at birth, these vascular birthmarks range from pale pink to dark red or purple and can appear anywhere on the body, although they show up most often on the face or head. They're similar to nevus simplex, but bigger. About 1 in 300 infants is born with a port-wine stain. Light port-wine stains might fade, but most endure and get bigger as the child grows. Sometimes port-wine stains can thicken and darken (the birthmark on former Russian president Mikhail Gorbachev's head is one example). They can also form cobblestones, or small lumps, on the surface of the skin over the course of decades.
• Hemangioma or "strawberry birthmark": Flat or raised growths composed of extra blood vessels, that often look like a strawberry-colored lump (deeper hemangiomas are more bluish-red). Hemangiomas affect up to 5 percent of babies, occur mostly on the head and neck, and tend to grow rapidly. Most hemangioma are benign and, after an initial growth spurt, gradually shrink and disappear as your child gets older. However, depending on the location and size, some may need treatment.

Do birthmarks require medical attention?

Most birthmarks are harmless, and many go away on their own in the first few years of life.

There are a few exceptions. In fact, 40,000 U.S. children a year have birthmarks that need medical attention. So, it's important to have your child's healthcare provider take a look at all of your child's birthmarks. Potential problems include:

• Port-wine stains near the eye and cheek are sometimes associated with vision problems like glaucoma, or with developmental delay. (This is known as Sturge-Weber syndrome.)
• Large hemangiomas, depending on where they're located, can interfere with eating, seeing, or breathing. Hemangiomas can sometimes grow internally, threatening the health of an organ. Others can be cosmetically disfiguring.
• Birthmarks on the lower spine may extend beneath the skin and affect the nerves and blood flow to the spinal cord.
• Groups of six or more café au lait spots may be a sign of a genetic disorder called neurofibromatosis type 1 (NF1). Children with NF1 usually have the spots at birth or by age 2, although the number of spots may increase in childhood and occasionally later in life. It's common for people with NF1 to have mild learning disabilities.
• Certain especially large moles that are present at birth have an increased risk of eventually becoming cancerous.
• Prominent or disfiguring birthmarks can become psychologically damaging to a child over time.

Birthmark removal: Will my child need to have their birthmark removed?

It depends. Some of the birthmarks mentioned above (like a hemangioma pushing on the eye) may require removal.

For others, the decision is controversial. Because so many birthmarks fade on their own without causing any physical problems, your child's doctor may suggest patience rather than treatment if a birthmark isn't disfiguring or causing physical problems. Some experts have challenged this wait-and-see approach, though, arguing that early intervention to treat certain birthmarks can be helpful because enough of them don't go away on their own.

If you're worried about your child's birthmark, talk with his doctor (and get a second opinion, if necessary) about options for treatment.

Are there any treatment options for birthmarks?

Depending on the birthmark, treatment and birthmark removal options include surgery, laser therapy, freezing (cryotherapy) and (in the case of certain hemangiomas) topical, oral, or injected steroids or topical or oral beta-blockers. Keep in mind that surgical birthmark-removal treatments can cause some scarring.

While port-wine stains could not be treated in the past, the introduction of the first pulsed-dye laser in the 1980s revolutionized the management of these birthmarks, especially on the face.

How can I help my child understand their birthmark and deal with any embarrassment it may bring?

Having a birthmark, especially if it's very visible, can make your child feel self-conscious and different. It might also attract unwanted attention, especially from other children.

When your child is old enough to understand, talk openly with her about the birthmark. Let them know they are no different from anyone else. In fact, you could even highlight the birthmark as something special and colorful that they have. This can help her accept it as just another part of who they are.

If your child is heading to daycare, preschool, or school, talk with the staff beforehand about the birthmark and about your child's feelings about their appearance. Work with them to ensure your child has a supportive environment and isn't bullied by other kids.

If you notice someone pointing or staring at your child, or if someone makes insensitive remarks about the birthmark, explain in a friendly and matter-of-fact manner that your child has a birthmark. Model and also practice with your child how to cope with these situations. For example, they might want to practice saying "It's a birthmark that I was born with.".

Online support groups can also be a good resource. To find one, check out this list of groupsOpens a new window from The Vascular Birthmarks Foundation.

For more birthmark information and referrals, visit the American Academy of DermatologyOpens a new window or the Vascular Birthmarks FoundationOpens a new window websites.

Find out more here about children's skin conditions.