Treatment

Most birthmarks are harmless and some disappear without treatment.

Some birthmarks may need to be treated for medical reasons, while some people may choose to have a birthmark treated for cosmetic reasons.

Haemangiomas

Haemangiomas sometimes disappear without treatment, but they often don't change untilyour child istwo years old.

Haemangiomas willsometimes disappear by the time a child reaches five years of age.In other cases, theymay lastuntil a child is12.

Plastic surgery may be an option ifa haemangioma has left the skin deformed or stretched. The aim of surgery will be to improve the appearance of the distorted skin.

If the haemangioma has formed an ulcer, extrameasures may need to be taken to prevent infection, and surgery or laser treatment may be offered.

Haemangiomas on the lip or around the nappy area are more likely to form ulcers that can sometimes bleed and be painful.

The exact treatment will depend on where and how severe the haemangioma is. Most haemangiomas can be effectively treated with medicine, such aspropranololwhich is given by mouth as a liquid. This will shrink the birthmark.

If propranolol doesn't work, other medicines can be used, such as steroids or vincristine. Surgery is rarely necessary.

If your child has breathing difficultiescaused bya haemangioma in their airway, they may need laser treatment.

This will usually be carried out during an examination of their airway using a small telescope called an endoscope. The procedure is known as microlaryngoscopy and bronchoscopy. They may also be given propranolol (see below).

You can read more about microlaryngoscopy and bronchoscopy on the Great Ormond Street Hospital for Children (GOSH) website.

Occasionally, a child with a haemangioma in their airway may need to have a temporary tracheostomy (an artificial opening in the windpipe) to improve their breathing.

Propranolol

Medication may be recommended if the haemangioma is complicated or large. This is usually a beta-blocker called propranolol.The full side effects of usingpropranolol to treat a haemangiomaare still being monitored.

Beta-blockers work by blocking the release of noradrenaline in certain parts of the body. Noradrenaline is a chemical released by nerves when they're stimulated. The noradrenaline passes messages to other parts of the body, such as the muscles, blood vessels and heart.

It's thought that propranolol helps narrow the blood vessels, reducing the amount of blood flowing through them. This makes thehaemangioma lighter in colour and softer. The cells that cause the haemangioma to grow are also affected so that it gets smaller.

Haemangiomas often leave a patch of stretched and thinned skin, with a small amount of swelling of the tissues under the skin. This is barely noticeable inmost areas.

However, in areas such as the nose, lips, ears and cheek, these small changes can be unsightly. In these areas, treatment with propranalol may be considered during the first few weeks of life, immediately after the haemangioma has been diagnosed, so that the long-term appearance can be improved.

Monitoring internal haemangiomas

If your child hasa haemangioma in aninternal organ, they may need an ultrasound scan or magnetic resonance imaging (MRI) scan to confirm its location and size. MRI scans use a magnetic field and radio waves to produce detailed pictures of the inside of the body.

Capillary malformation (port wine stains)

Capillary malformation (port wine stains) are permanent, but treatment helps fade the mark, making it less noticeable. You can also disguise it using cosmetics.

Laser treatment

Laser treatment isthe only treatment for a port wine stain. It lightens the affected area of skin. Laser treatment often works better in younger children because in adults a port wine stain may become bumpy and raised after a number of years.

The most common type of laser treatment is pulsed dye laser treatment. The laser passes through a fibreoptic cable. On the end of the cable is a device that looks like a pen. It's gently held against the surface of your child's skin and a button is pressed, which sends a beam of light to the skin.

The light goes less than 1mm into the skin. It's absorbed by the blood vessel just beneath the surface, causing it to heat up. The heat damages the blood vessel, which creates a bruise that will fade within a week or two.

During or after treatment, your child's skin will becooled to reduce discomfort. A jet of cold air may beblown onto the skin during treatment.

Some of the possible side effects of laser treatment include:

• bruising after some types of laser treatment, it's normal for the mark on the skin to look worse because of bruising, but thiswill fade after one to two weeks
• pain the laser stings, somost children have laser treatment under general anaesthetic (where they'reput to sleep), butsome children can tolerate treatment with the help of a local anaesthetic cream that numbs the skin; a cold gel pad may also be put on the area before treatment to minimise any discomfort
• increased sensitivity to sunlight your child's skin will be very prone to sunburn for up to six monthsafter laser treatment

Between three and 30treatment sessions may be needed at intervals of six to eight weeks.

How effective the treatment is will depend on how prominent and dark the affected area is. The best results are often seen in marks that are already smaller and lighter.

Camouflage make-up

You can get a prescription for a special type of camouflage make-up thatcovers up the birthmark.

The charity Changing Faces now runs the skin camouflage service previously run by the Red Cross . You can book an appointment with a trained volunteer, who can teach you to apply the make-up.

You can also read more about skin camouflage on thewebsites of the British Association of Skin Camouflage and the Skin Camouflage Network .

Congenital melanocytic naevi (CMN)

As congenital melanocytic naevi (CMN) can affect a person's appearance, surgery may be considered. However, surgery will leave scarring and may not be possible if the affected area is very large.

Surgery involves removing the birthmark and stitching together the edges of skin. If the area is large, a skin graft may be needed. This involves taking skin from anotherpart of the body and using it to cover the wound.