Vascular Changes or Birthmarks

A newborn baby's delicate skin is prone to a wide array of conditions. Some of these are due to heredity, such as birth marks, but some rashes are due to the mother's hormones still circulating throughout the baby's blood stream. While some of these skin lesions are normal, some may be an indicator of underlying problems and the most common newborn skin lesions are :

Vascular changes or birthmarks Transient vascular changes Acrocyanosis (Blue hands and feet)

• A purplish blue colour around the lips, hands and feet which is normal in newborn babies.
• This is most noticeable when the baby is cold or during crying.
• This is due to the baby's immature system in adjusting to cold exposure and is normal. Baby should be active and feeding well.
• To exclude any other causes, do the following :
  • Periksa suhu badan untuk mengesan demam
  • Periksa bibir, lidah dan gusi, jika kebiruan bayi tersebut mesti dibawa berjumpa doktor dengan segera.

Cutis marmorata

• A marbled or mottled look of the skin of a newborn caused by the uneven distribution of blood flow about the skin.
• The newborn is not very adept at adjusting when exposed to heat or cold. When a baby is exposed to the cold, the flow of blood in the skin becomes irregular. This is often accompanied by uneven flow of blood to the hands and feet. So it is not uncommon for newborn babies to have a bluish colouration to these parts of the extremities (acrocyanosis).
• This is normal and generally resolves after 2-3 weeks. If it does not resolve by then, please see a doctor to check for genetic disorders.

Vascular Birthmarks

These are vascular skin lesions present at birth or in the first few months of life. They are common and most disappear as the child grows. Some birthmarks may be an indicator of other diseases.

Check with your doctor or nurse at the nearest government clinic during the baby check-ups in the first few weeks of life or at your 6th week postnatal visit.

Salmon patch

These are dilated capillaries in the skin which are left-over patches of the way the blood vessels looked during the fetal circulation.

• Occur in 40 -60% newborn babies
• Flat, dull pink patches usually found on the back of the neck, forehead above the nose, upper eyelids
• Colour may deepen with crying
• Usually disappear within the first year and do not cause any problems
• No treatment is required

Strawberry haemangioma

• Haemangioma
• Usually begins as a faint red mark on any part of the body around one to four weeks of age
• Bright red, becoming raised and lumpy, like a strawberry, growing over the first six months of life
• Stops growing after six to twelve months of age and then gradually shrink in size, disappearing over a few years

Treatment

• In most cases, treatment is to wait for natural resolution
• Avoid trauma to the haemangioma. Wear mittens for baby or keep baby's nails short to avoid accidental scratching
• Maintain hygiene especially in areas around the groin or other skin creases
• In cases where the haemangioma grows over the eye and blocks vision, treatment is required and available at eye specialist and paediatrician clinics. This is to prevent the loss of vision in that eye. Available options for treatment are laser therapy, interferon, steroid injection into the haemangioma, or oral steroids.

Port-wine stain

Port-wine stains are different from these common vascular birthmarks in a number of important aspects. They occur in 0.1-0.3% of newborn babies.

• Malformation of capillaries or veins arising in the deeper layers of the skin (dermis)
• Present at birth as red, flat and generally on one side of the face or neck, but any part of the body can be involved
• Untreated, it persists throughout life
• Over time, it can become more thickened, with a cobbled look and darkened in colour

Treatment

• Laser treatment under local anaesthesia, usually at a later age when the child can cooperate.
• Interferon for infants where the vessels involved are deeper.

See the doctor immediately if the port wine stain:

• is over one side of the forehead or over eye - to look for underlying abnormalities on the same side of the brain (Sturge-Weber syndrome) and to check the eyes for glaucoma as early treatment is crucial
• involves large areas of the trunk or limbs - large vascular malformation in one limb may cause the limb to grow faster than the other unaffected side or cause the platelet count to drop. A low platelet count may lead to an increased risk of bleeding (Klippel -Trenaunay-Weber syndrome)