Birthmarks: A tale of two colors and the magic wand
A child is born with smooth, flawless skin and all is right in the world. However, soon enough, a mysterious spot or small patch, be it red or light blue-grey, presents itself in the landscape of innocent infant skin, be it in the face, trunk or extremities, and suddenly, all is not well as it seems as it grows and changes with the passage of time.
Hence, the tale of two birthmarks begins – one type colored red and fueled by the activity of blood vessels, and the other, colored bluish grey, spurred on by a deposition of pigment in the deeper layer of the skin.
The more common red birthmarks are known as superficial hemangiomas and portwine stains. A superficial hemangioma, or strawberry hemangioma, seen as a bright red bump on the skin, follows a usual course of growth within the first year of life then stabilizes at age one.
Thereafter, spontaneous involution begins – red color replaced by whitish, oftentimes loose skin alongside a decrease in lesion size – with a rule of thumb of 30 percent involution by age three, 50 percent involution by age five, and so on.
A portwine stain, more commonly seen on the face, is a red-pink to mauve colored smooth patch that intensifies in color with time and if left untreated, becomes nodular and rough in adulthood. For pigmented birthmarks, the usual lesion that attracts attention is termed Nevus of Ota, which presents as a light grey to bluish grey, small to large area of skin discoloration on the face.
Active treatment for these birthmarks covers both medical and quality-of-life domains. Rapidly enlarging hemangiomas may exhibit ulceration, recurrent infection or obstruction if near a body orifice. A nodular portwine stain on the upper eyelid of an adult may cause drooping of the lid from the weight of the lesion and eventually pose a risk to vision. A Nevus of Ota lesion or a facial flat portwine stain may be a reason for bullying of a schoolchild and be a source of psychological stress which may unfortunately be carried on to adulthood and affect work and social opportunities.
Modern-day technology brings us the wonder of laser treatment, a magic wand fit for these birthmarks. The physics of laser energy dictates selective damage of identified targets while sparing uninvolved skin structures. The light energy emitted by a true laser device is crafted to be specifically absorbed by either the blood flowing in the vessels of red birthmarks or the melanin in pigmented birthmarks.
The use of the pulsed dye laser is well-studied and documented in halting purely superficial hemangioma growth and inducing early regression. It likewise delivers a solid clinical outcome in fading portwine stains to a faint blush with serial treatments.
For Nevus of Ota lesions, both the alexandrite and neodymium yag lasers are the frontrunners in ensuring an oftentimes, life-changing clearance of the lesion. Treatment is safe even in young children given the high precision that laser technology affords. These are outpatient procedures that are normally done with the use of topical anesthesia. Proper eye protection and ideal spacing of sessions are standards of careful treatment.
The accessibility of these devices at the St. Luke’s Dermatology Center of both Global City and Quezon City coupled with the relatively recent addition of PhilHealth assistance for several sessions of laser treatment for these birthmarks has made this arm of patient care a reality for a growing number of Filipinos… the magic of science with fairy dust for a happy ending to the tale of two colors.
Dr. MARIA PILAR LAGDAMEOLEUENBERGER is the current Head of the Department of Dermatology of St. Luke’s-Global City. She obtained her medical degree from the University of the East Ramon Magsaysay Memorial Medical Center College of Medicine and completed her residency training in Dermatology at the same institution. Thereafter, she obtained training in dermatologic laser surgery at the Massachusetts General Hospital Dermatology Laser Center, an affiliate of the Harvard Medical School in Boston. Dr. Leuenberger is a Fellow of the Philippine Dermatological Society.