Birthmarks in Children

While birthmarks are common, not everyone is born with one. There are different types of birthmarks and they vary in size, colour and texture. Birthmarks are usually harmless but in some cases, they require treatment and intervention.

What are Birthmarks?

Birthmarks are discoloured areas or abnormal patches of skin that develop before birth or a few weeks after. They consist of overgrown pigment cells or incorrectly formed blood vessels.

What causes Birthmarks in Children?

The exact cause of birthmarks and why they develop have yet to be understood, although some types do run in families.

What are the different types of Birthmarks in Children?

The most common types of birthmarks that children have are vascular, made up of incorrectly formed birthmarks, and typically red in colour.

They are divided into two types: infantile hemangiomas and port-wine stains. Hemangiomas are relatively common, occurring in 1-2% of babies. They occur more commonly in premature babies, twins, and females.

There are also pigmented birthmarks that consist of pigment cells that cause patches of colour on the skin, ranging from tan, brown, blue, white, grey, or black. Congenital melanocytic nevus (moles) can also be birthmarks.

Types of BirthmarksAppearanceComplications
Port-wine stains
  • Appears at birth as a pink to purplish flat patch on the skin.

  • Can happen anywhere on the skin.

  • May lighten in the first year of life but it can get darker and more pronounced in puberty.

  • Usually increases proportionally as
    the baby grows.

  • Typically benign.
  • In a minority of cases where it involves the face or limbs, further investigation may be advised.
  • Eczema and other skin conditions can cover over the port wine stain.
Infantile Haemangioma
  • A collection of small blood vessels in the superficial or deeper skin.

  • Rarely, they can be present in other organs like the liver.

  • Usually not present at birth, but appears in the first 2 weeks of life and grows very fast in the first 4-5 months of age. Thereafter, the rapid growth slows down. It slowly shrinks in size after the first 1-2 years of age, at a rate of 10% per year.

  • After it goes away, the skin may not be entirely normal. There may be residual small blood vessels, called telangiectasia or uneven skin texture, colour and even scarring.

  • Haemangiomas that occur near the eye, mouth, and nose can cause problems with vision, feeding, and breathing respectively.

  • Large haemangiomas on the beard area can be associated with haemangiomas in the deeper airways.

  • Large haemangiomas on the head and neck can be associated with brain, eye, or heart abnormalities. Large haemangiomas at the groin area can be associated genital or spinal abnormalities. These haemangiomas should be investigated further with scans and appropriate referrals.

  • Large haemangiomas, especially those in the groin and flexures,can ulcerate, bleed, and get infected. These haemangiomas should be treated without delay.

Café au lait macules (CALMs)
  • Flat, brown colour patches that can occur at birth or in early childhood.

  • Most children have one or two small CALMs that may disappear or stay with them for life.

  • They grow proportionally with the child and are usually benign.

  • When CALMs occur in large numbers, the doctor may want to run further tests to exclude genetic diseases.

  • None other than the cosmetic appearance in visible areas.
Pigmentary mosaicism
  • Patterns of either darker or lighter skin tones on the child’s skin. These can appear on one side of the body or limb or cross in between the sides too.

  • They can be quite extensive and cause anxiety among family members.

Epidermal Nevus
  • Relatively common benign linear birthmarks that are present at birth.
  • They occur as a result of thickening of the top layer of the child’s skin.
  • They appear as tan to brown little papules that can grow proportionally bigger with age.
  • They can get red and inflamed as well.
  • They can be left alone during childhood but can get bulkier after puberty.
  • None other than the cosmetic appearance in visible areas.
Nevus Sebaceous
  • Relatively common congenital birthmark that consists of increased numbers of oil glands.


  • Occurs most commonly on the child’s face and scalp.


  • Usually present at birth as a single yellow to orange hairless linear birthmark on the head and neck area.


  • Secondary growths may occur on the birthmark as the child grows into an adult.

  • May lead to cosmetic
    disfigurement, interferes with personal grooming like combing, or suspicion of cancerous change.
Congenital melanocytic nevus (CMN)
  • Also known as moles present at birth or within the first year of life.


  • Present as brown to black flat or slightly raised lesions anywhere on the child’s body. Pigment variation and increased hairs may be seen. With time they can get thicker.


  • Classified according to their greatest diameter in adulthood. Small (<1.5cm), medium (1.5cm to 19.9cm), large (>20cm).

  • There is a slightly increased risk of cancerous change but the risk is low in small and medium sized CMN. The risk is higher in large CMN.
Nevus depigmentosus
(white birthmarks)
  • Presents at birth as a white patch or may be more obvious after the first few months of age. There is usually no family history or white patches.


  • Grows proportionally with the child.

  • It happens due to localised malfunctioning pigment cells in the skin.

  • Sun protection is very important.

What are the treatment options for Birthmarks in Children?

While most birthmarks don’t require treatment, some types like infantile haemangioma can cause problems with vision or breathing in children. For aesthetic purposes, some people choose to treat their children’s birthmarks by removing them. Consult a dermatologist that is specialised in paediatric birthmarks and skin disorders if you have concerns about your child’s birthmark.

Type of BirthmarkTreatment Options
Port-wine stains

Pulse dye laser

  • Advisable to start early.
  • Repeated sessions (4 to 6 weekly) may be required.
Infantile Haemangioma

Although most haemangiomas do not require treatment, there are some factors that require treatment without delay:

  • Size and site of the haemangioma, potential for complications will determine the need for treatment.
  • There are topical treatments available for superficial haemangioma. Deep haemangioma requires oral medications.
  • Lasers such as Pulse dye laser can be a treatment option for superficial haemangiomas too.
Café au lait macules (CALMs)Does not require treatment.
Epidermal NevusSurgical excision, electrosurgery or lasers can be used to remove the lesion.
Nevus SebaceousSurgical removal is recommended for larger lesions.
Congenital melanocytic nevus (CMN)For large CMNs your doctor may advise for brain and spine scans.
Nevus depigmentosus (white birthmarks)There is no specific treatment. However, it is advisable to rule out other causes of white patches in the skin.

Who is at risk of Birthmarks in Singapore?

Any child can develop birthmarks, as approximately 10% of all babies are born with them.

How are Birthmarks in Children diagnosed?

A healthcare professional or paediatric dermatologist can identify and diagnose your child’s birthmark based on appearance or through imaging tests such as biopsies, magnetic resonance imaging (MRI), ultrasound, and computed tomography scans.


Are birthmarks in children serious?
Most of the time, they are harmless. However, in some cases, they can be an indicator of a serious medical condition. Consult a paediatric dermatologist if you are concerned about your child’s birthmark.
When should you worry about a birthmark?
Consult a doctor if your child’s birthmark has gotten bigger, changed in colour or texture, or is painful.
What is the reason for birthmarks?
Incorrect forming of blood vessels (vascular) or overgrowth of pigmentation cells is a main cause of birthmarks in children.
Is it normal for my baby to have a birthmark?
Yes, approximately 10% of babies are born with birthmarks.
Should you remove birthmarks in children?
While most birthmarks don’t have to be removed for medical reasons, you can do so for cosmetic purposes through laser therapy or surgery.



Dr Uma Alagappan is a MOH accredited consultant dermatologist in private with more than 15 years experience as a medical doctor. She sub-specialises in paediatric dermatology, women’s dermatology and general dermatology. Dr Uma’s interests include chronic eczema, food allergy and immunodermatology. She is also well versed with the use of lasers for treating paediatric and adult patients.
Dr Uma completed her dermatology training in Changi General Hospital and National Skin Centre in 2015. She joined KKH Dermatology Service to subspecialize in paediatric dermatology in 2017. She was awarded the Ministry of Health Manpower Development Plan Award in 2019 to pursue paediatric immunodermatology and allergo-dermatology in the renowned Boston Children’s Hospital, Massachusetts, USA. Upon her return, she spearheaded a number of clinics at KKH including the food allergy eczema clinic for the paediatric eczema patients, immunodermatology clinics and the psychology eczema multi-disciplinary clinics.
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