The term birthmark comprises a wide range of both vascular and pigmented skin conditions. These conditions are present at birth or appear early in life. Birthmarks can occur anywhere on the body. Two of the most common names for these skin conditions are port-wine stains, which are red vascular birthmarks, and coffee-and-cream birthmarks, which are brown and composed of melanin (skin pigment).
Until the early 1990s, there were really no significantly effective treatments for either port-wine-stain or coffee-and-cream birthmarks. With the introduction of high-energy pulsed lasers, physicians gained access to technology they could use to remove or improve both vascular and pigmented birthmarks.
Lasers work by emitting powerful pulses of energy that selectively target abnormal vessels or pigment cells. With laser treatment, port-wine-stain birthmarks can be greatly lightened and sometimes completely removed. Coffee-and-cream birthmarks can be removed in almost all cases; however, 50 percent of these will recur at some point.
Treatment length varies with the size of the birthmark. A small birthmark may require only a few minutes of laser treatment. Larger birthmarks may require as long as an hour to treat. Multiple treatments are generally necessary to significantly lighten or remove vascular birthmarks.
Port-wine stains are best treated in the first few weeks of life because they are most responsive during that period of time. However, they can be effectively treated at any time throughout an individual’s life. Coffee-and-cream birthmarks also appear to respond better to early treatment. However, the data on coffee-and-cream birthmarks is less clear as far as optimum treatment time than it is for port-wine stains.
Laser treatment of birthmarks is not a major surgery. In the past, patients have reported discomfort during the procedure. Today, new contact cooling devices and dynamic cooling devices, which spray cold liquid onto the skin prior to laser impact, have greatly reduced the discomfort associated with laser treatment.
Basically, there is no recuperation period after removal of vascular or pigmented birthmarks. There is some bruising that occurs from treatment of vascular birthmarks, but it usually only takes about a week or two for the bruising to disappear. Also, there is no pain or at most only minimal discomfort following laser treatment.
There have been reports of port-wine stains recurring after laser treatment, but this is rare. However, 40 to 50 percent of coffee-and-cream birthmarks may reappear after successful removal. This is because the laser only targets the melanin (skin pigment) which is at the surface of the skin. Melanin deep within the epidermis is not affected. In time, this melanin may come to the surface and result in a lighter coffee-and-cream birthmark in the same area. In these cases, laser treatment may be repeated.
If your child has a port-wine stain birthmark, it is important that he or she be examined by a physician as soon as possible. This particular birthmark can be associated with underlying abnormalities of the brain and the eye. In general, isolated coffee-and-cream birthmarks are not associated with any underlying abnormality. Remember, both of these types of birthmarks are most effectively treated as soon as possible after birth. However, they can be treated at any point in life.
If you or your child has a birthmark you would like to have removed, consult with a laser surgeon that is very familiar with the diagnosis and treatment of these skin conditions. Experience counts when it comes to effectively treating birthmarks. When interviewing a physician, ask about his or her level of experience, board certification, the number of similar cases he or she has treated, and how many cases a month he or she treats. A good indication of a laser surgeon’s level of experience is whether or not the surgeon owns his or her laser. If surgeons do not own their equipment, it is often an indication that they do not perform the procedure regularly enough to make owning their own equipment cost-effective. Lack of experience is the most common reason associated with complications and unsatisfactory clinical outcomes.
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