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Ex­pert ad­vice on types of birth­marks and the treat­ments avail­able

Little Treasures - - EXPERT ADVICE -

DR SWEE TAN has seen many Kiwi ba­bies, chil­dren and adults at the Cen­tre for the Study and Treat­ment of Vas­cu­lar Birth­marks, which he founded at Hutt Hospi­tal in 1996. Dr Tan spoke to Lit­tle Trea­sures about the dif­fer­ent types of vas­cu­lar birth­marks that can af­fect our kids, and what can be done about them.

What are the main types of vas­cu­lar birth­marks?

There are many types, tu­mours and malformations, af­fect­ing up to 12 per cent of the pop­u­la­tion and they all need dif­fer­ent treat­ment. They’re present at birth, grow pro­por­tion­ately with the child and can sud­denly ex­pand in re­sponse to hor­monal changes or trauma. The most com­mon type of vas­cu­lar tu­mours are straw­berry birth­marks, also known as in­fan­tile hae­man­giomas. The most com­mon form of vas­cu­lar malformations are ve­nous malformations that af­fect veins in a par­tic­u­lar part of the body. Port wine stains are a vas­cu­lar mal­for­ma­tion that af­fect cap­il­lar­ies, usu­ally of the skin, so they are vis­i­ble.

Why do they hap­pen at birth?

The word ‘birth­mark’ is ac­tu­ally not quite an ac­cu­rate term for straw­berry birth­marks be­cause 40 per cent are not present at birth. They’re usu­ally no­ticed dur­ing the first 2-3 weeks of life as a pink patch or di­lated cap­il­lary ves­sels if they af­fect the skin. How­ever, some aren’t no­tice­able un­til 2-3 months of age if they af­fect the tis­sue un­der­neath the skin. Our re­search has shown that straw­berry birth­marks are caused by stem cells from the placenta that travel to the baby in utero.

Where straw­berry birth­marks usu­ally ap­pear?

Straw­berry birth­marks af­fect up to 10 per cent of newborns in New Zealand. About 60 per cent of them af­fect the face and neck area and they range from re­ally tiny to some­thing very big – some can even cover half the face. But most are gen­er­ally small and don’t cause any trou­ble, ex­cept for cos­metic ef­fect.

Do they go away?

Mostly. They can grow for 9-10 months, al­though they are all dif­fer­ent. Usu­ally, they will grad­u­ally shrink on their own spon­ta­neously, al­though that can take five, some­times 10 years. About 10-15 per­cent of straw­berry birth­marks need in­ter­ven­tion in the first year of life. Over­all, about a quar­ter of them will re­quire some sort of in­ter­ven­tion, even when they have shrunk.

Which type of straw­berry birth­marks re­quire med­i­cal in­ter­ven­tion dur­ing in­fancy?

If they cause a threat to func­tion, for ex­am­ple, if the birth­mark is around the mouth, the baby might not be able to feed prop­erly; if it’s on the nose or wind­pipe it might af­fect breath­ing; near the eye, the baby may go blind. About five per cent of straw­berry birth­marks can be­come ul­cer­ated and cause pain and bleed­ing and can be­come in­fected. This causes dis­tress to the baby and par­ents. Oc­ca­sion­ally when these straw­berry birth­marks are very large, es­pe­cially those that af­fect the liver, a lot of blood flows in and out of it and in fact it can cause heart fail­ure.

What is the treat­ment for straw­berry birth­marks?

We can ma­nip­u­late these birth­marks with spe­cific med­i­ca­tion to cause them to ‘com­mit sui­cide’. The med­i­ca­tion is pro­pra­nolol, which is usu­ally used to treat blood pres­sure. It works very dra­mat­i­cally on straw­berry birth­marks, with most re­spond­ing re­ally well and shrink­ing within a few days.

What about ve­nous malformations?

Ve­nous malformations are the most com­mon type of vas­cu­lar malformations, af­fect­ing one per cent of the pop­u­la­tion (one per cent of these run in the fam­ily). Those sit­u­ated un­der­neath the skin look bluish in colour and can get con­fused with straw­berry birth­marks that af­fect the tis­sue un­der­neath the skin.

What is the treat­ment for ve­nous malformations?

Ve­nous mal­for­ma­tion may cause func­tional prob­lems such as pain and loss of func­tion and cos­metic con­cerns be­cause of the dis­tor­tion of the af­fected part of the body. The treat­ment is usu­ally post­poned un­til the child is older and it in­volves surgery or al­co­hol in­jec­tions, and some­times both.

What about port wine stains?

Port wine stains are caused by mal­for­ma­tion in the cap­il­lar­ies. The di­lated cap­il­lary ves­sels in the af­fected skin fill with blood, which causes the colour of the stains, which can be pink, red or pur­ple. They can af­fect any part of the body but the face is most com­mon. They af­fect about 0.3 per cent of the pop­u­la­tion. Al­though they’re not com­mon, they can cause sig­nif­i­cant cos­metic con­cerns for the child and the par­ents.

Port wine stains can look striking, but are they harm­less?

Port wine stains are largely a cos­metic prob­lem. Those that af­fect the face can be as­so­ci­ated with a con­di­tion called Sturgewe­ber Syn­drome, which can cause neu­ro­log­i­cal prob­lems such as seizures and also glau­coma. Un­treated port wine stains grad­u­ally darken and the skin may be­come thick­ened and there is some­times over­growth of the soft tis­sue and even the bone of the face.

What is the treat­ment for port wine stains?

Pulsed dye laser treat­ment is the stan­dard treat­ment, with an av­er­age of 8-10 ses­sions. They are painful and usu­ally need to be per­formed un­der a general anaes­thetic in chil­dren. Port wine stains can be re­moved com­pletely in about one out of three pa­tients and you can get im­prove­ment in the rest.

What is your ad­vice to par­ents?

See your GP to get the right in­for­ma­tion and ad­vice early. There are many dif­fer­ent types of vas­cu­lar birth­marks and they re­quire dif­fer­ent forms of treat­ment. For many, the right man­age­ment is to do noth­ing and watch.

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