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When should parents be concerned about a birthmark on their child?

Birthmarks refer to patches of discoloured skin on a baby’s body, present at birth or appearing a few months later.  Most birthmarks are painless and harmless. They usually fade over time and sometimes even disappear completely. Read on to learn all about birthmarks.


Pigmented birthmarks can appear anywhere on the body. Café au lait spots and Mongolian spots – the most common types – are caused by dilated capillaries near the surface of the skin.

Café au lait spots, salmon-coloured patches that tend to darken when exposed to the sun, usually fade as the child gets older. Groupings of these spots (six or more) may be a sign of a genetic disorder called neurofibromatosis type 1.

Mongolian spots are more prevalent on darker skinned babies. Bluish in colour and resembling bruises, they often appear on the buttocks, scrotum, lower back and sometimes on the trunk or arms.

Another common birthmark is a mole. Moles often darken after sun exposure and during the teen years and pregnancy. Certain moles can increase in size or may become cancerous.


An accumulation of blood vessels below the skin’s surface causes vascular birthmarks. Depending on the depth of these vessels, they present as pink, red or blue marks. The most common vascular marks are harmless macular or flat stains, usually pink in colour. Often called “angel’s kisses” or “stork bites” because of their appearance on the forehead, eyelids, nose, lip or back of the neck,  they tend to darken when babies cry or their temperature is raised. Facial marks usually disappear by age two while the marks on the back of the neck may last until adulthood.


Hemangiomas are flat or raised marks that usually appear a few weeks after birth. Strawberry hemangiomas, brighr-red raised lesions, commonly occur on the face, scalp, back or chest.  They grow quite rapidly and often disappear between the ages of five to 10.

Cavernous hemangiomas appear as a red-blue spongy tissue with borders that aren’t as visible as they are with other hemangiomas. They grow rapidly in the first six months, then slow down and often disappear by age 10.

Port-wine stains are flat purple-to-red marks usually occurring on the face. Lighter port-wine stains may disappear. However, in most cases, they remain and get bigger as the child grows. These marks sometimes also thicken and darken to form “cobblestones” or lumps. Port-wine stains near the eye and cheek accompanied by seizures at birth as well as eye problems, may be evidence of a neurological disorder called Sturge-Weber syndrome.

Should I be worried?

Sister Bronwyn Lendrum from Netcare Stork’s Nest in Sunninghill says “most babies are born with some form of birthmark. In the majority of cases, these are hormonal and usually disappear within two years”.

Johannesburg-based GP Dr Paula Smart says that if there is scarring or the birthmark looks more than just cosmetically unappealing, she would refer the child for further medical advice. However, she prefers to simply monitor them for two years.

Dr Michael Jameson, a Johannesburg-based dermatologist, agrees that if the birthmark is uncomfortable, prone to bleeding, situated near the mouth and nose or obstructing vision you should consult your doctor or dermatologist. He also advises consulting your doctor if you have any concerns. “It’s not always possible to see whether a birthmark poses a danger by mere surface observation. Certain birthmarks can present themselves subcutaneously.”

Chareen Boake

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