A new Mom shares her initial worries and the latest information on some common infant conditions.

“Come here and take a look at this,” my son’s pediatrician said, as he motioned to two nurses standing outside of the exam room. Roughly one week earlier, I had discovered a small, flat, red line on the corner of my son’s lower left lip.  He was a voracious nurser, so I believed that the line was some sort of nursing blister.  I thought it would go away in a few days.  But a week later, my husband and I noticed that it had not changed, so I immediately made an appointment with the pediatrician.  The nurses came into the exam room, and the doctor put his gloved finger on my baby’s lip.  The three of them looked intently at the red line, while my stomach lurched to my throat.  In the meantime, my precious 4-week-old lay peacefully on the examining table staring at me, the doctor, and the Winnie the Pooh wallpaper, blissfully oblivious to what was happening around him, and to his mother’s increasing fears.

“What is it?”  I asked, barely able to get the words out.

“It’s a hemangioma, a vascular birthmark,” was our doctor’s reply, one that would initiate a flood of research in the days, weeks, and months to come, in order  to alleviate my fears.

According to the American Academy of Dermatology (AAD), of the nearly four million children born in the United States each year, ten percent are born with a vascular birthmark. Ninety percent of these birthmarks disappear by one year of age, and the remaining ten percent are diagnosed as vascular lesions not significant enough to warrant the opinion of a medical specialist. Vascular birthmarks are made up of blood vessels that are bunched together within the skin. They can appear flat or raised and have a red or blue color.  There are several different kinds of vascular birthmarks, the most common ones being port-wine stains and hemangiomas.

Port-Wine Stains

Port-wine stains are classified as vascular malformations. According to the AAD, they occur in 0.3 percent of births and are found equally among males and females. Port-wine stains occur when an area of skin doesn’t receive an adequate supply of nerve fibers to help keep blood vessels contracted.  When such a lack of nerve fibers exists, capillaries (small blood vessels) keep expanding, allowing a large amount of blood to flow into them,  causing a stain to appear under the skin. They are commonly found on the face, but can appear anywhere on an infant’s body.  Port-wine stains appear flat, pink-red in color at birth, but darken to a reddish-purple during the child’s early years. Port-wine stains do not fade or go away.

Medical complications can arise with a port-wine stain depending on its location. According to Jessica Romano Roberson, MD, MS, pediatric oncologist/hematologist at Nemours Children’s Clinic in Orlando, port-wine stains tend to be “problematic, as they can be a sign of another syndrome, so they should be evaluated by another pediatric specialist, such as a neurologist.” A child with a port-wine stain on or near the eye area should have his or her eyes checked every year for possible symptoms of glaucoma.  Even though port-wine stains will never fade, there are ways to lessen their color and appearance. Laser therapy has been successful when a child is young, since the stain has not had a significant amount of time to grow or darken. As with any treatment, there are risks involved with the use of laser therapy─ swelling and patchy whitening of the skin are common.  Doctors also recommend the application of brand name cover-up foundations.

Hemangiomas

Hemangiomas are the most common, non-cancerous tumors found in babies, occurring in one to two percent of newborns, but as many as 10 to 12 percent of infants will have one by the time they reach their first birthday. Hemangiomas are caused by numerous tiny blood vessels bunching together.  According to the AAD, hemangiomas are more frequently found in newborn girls and in premature infants.

Hemangiomas typically progress through three-stages.  In the first stage, the hemangioma presents itself and undergoes a period of rapid growth. The second phase occurs with the lesion exhibiting little to no change. During the last stage, it changes color from bright red to light red, then acquires a grayish-white appearance before, finally, regressing into the skin.

Most vascular lesion specialists believe that treatment of hemangiomas should be on a case-by-case basis. The most widely used treatment is corticosteroids, such as prednisone. Prednisone is either injected into the hemangioma or taken by mouth for several months. Marilyn Liang, MD, pediatric dermatology assistant at Children’s Hospital Boston, explains that raised blood pressure and irritability (as a result of an upset stomach) are the most common side effects of these medications. “The long term side effects of steroidal treatment include bone density issues,” she says.  Once the hemangioma has entered the final stage, its appearance may not be cosmetically pleasing for either the child or the parents. Depending on the type of tissue remaining, surgical removal may be an option.

Research Breakthroughs

Researchers from Boston Children’s Hospital have discovered that a simple urine test may determine whether a birthmark is likely to develop into a threat to an infant’s future health.

“Many birthmarks caused by abnormal growth of blood or lymphatic vessels disappear with treatment,” states Marsha Moses, MD, associate professor of surgery at Harvard Medical School, and lead researcher in a clinical study on vascular birthmarks. “We can look at the urine of these children and predict the extent and activity of the abnormalities. This gives physicians data that they can use to treat children more effectively.”

Liang advises that, although urine testing is still being looked at in clinical trials, the results are promising.

As for my son, his hemangioma, having grown to the size of a thumbnail at one point,  has, over time, grayed considerably and regressed on its own. With our pediatrician’s advice, we chose not to use the steroidal treatment, but rather decided to let the hemangioma naturally regress over time. Had it interfered with his eating, our son would have had surgery to remove it. Today, he is a healthy and happy 10-year-old and his birthmark is no longer noticeable.