
Dr. Nur Aileen Wee binti Abdullah, Consultant Paediatrician And Paediatric Dermatologist, Growell Baby & Child Specialist Clinic (Ampang)
Every parent welcomes their newborn baby with the expectation that their baby is perfect and free from illness and birthmark. Hence, babies with birthmarks can pose parental distress and concern. Birthmarks can be of all sorts of colours depending on their underlying origin and cause. They may be in variable shades of red, brown, black or white.
The majority are harmless; most stay the same throughout the lifetime while some may resolve spontaneously; few worsen and few could be treated.
This time, I will focus on two common red birthmarks of vascular origin; salmon patch and port wine stain.
Let us learn more.
#1. Salmon Patch
What is salmon patch?
Salmon patch is the most common type of birthmark in newborns. It is also known as nevus simplex. They are seen in up to 8 out of 10 newborns [1]. They develop when clusters of blood vessels dilate, causing increased blood flow [2]. While the thin, delicate nature of the newborn skin makes these dilations easy to spot, they are completely harmless [2].

Figure 1: Salmon patch on mid-forehead and eyelids (angel’s kiss)[3]
How do they look like?
They are usually flat, pink to red stains or patches, noticeable from birth. Salmon patches are often located on the eyelids, forehead, back of neck, top of head, under the nose. Sometimes, they are also called stork bite (when located at the nape of neck) and angel’s kiss (when located between the eyebrows) [3]. They are usually seen at midline or can be one or both sides. They are not painful and not itchy. Do not be alarmed if the birthmark gets darker (or redder) when your baby becomes more emotional or active [4].

Figure 2: Salmon patch on the nape of neck (stork bite)[3]
What happens to salmon patch?
On most body sites, salmon patch commonly fades and disappears within the first 1 – 2 years of life. Salmon patch on the nape of neck (stork bite) has a 50% chance to persist indefinitely. But in view of the position of the birthmark, which is often covered by hair, cosmetic is not an issue. They are totally harmless and do not require treatment [4]. Nevertheless, pulse dye laser can be considered for salmon patch that may be persistent.
#2. Port Wine Stain
What is port wine stain?
Port wine stain, also known as nevus flammeus is red birthmark caused by abnormal development of blood vessels in the skin. It got its name because it looks like maroon wine spilled or splashed on the skin5. They are seen in approximately 3 out of 1000 newborns [1].

Figure 3: Illustration showing port wine stain on the surface and under the skin[5]

Figure 4: Port wine stain: typical red mark seen at birth
How do they look like?
They are usually flat and pink to red in colour early in life. They usually occur over 1 side of the face, can occasionally be seen on both sides as well. It can occur anywhere on the body but most commonly are on the face, neck, scalp, arms or legs[5]. They are not itchy and not painful.
What happens to port wine stain?
As they age, they may become darker, more purplish in colour, thicker and even develops small lumps. Thus, it is essential to treat them early to avoid the natural progression. Aesthetically, port wine stain can affect a child psychologically especially in school going age kids resulting in low self-esteem, depression and school avoidance.
What challenges can happen with port wine stains?
Small port wine stains have no associated diseases. But the large segmented ones may be associated with glaucoma and/ or Sturge Weber syndrome (blood vessel malformation of the brain). These children need to be investigated further and managed promptly. They will require referral to the paediatric neurologist and ophthalmologist for subsequent management.

Figure 5.1
Possible complications: red patch becomes darker purplish in colour and gets thicker (both figure 5.1 and figure 5.2) and development of small bumps (figure 5.2)

Figure 5.2
How is port wine stain treated?
Pulse dye laser is the treatment of choice for port wine stain. They are safe and effective for port wine stain on the face. However, it is not possible to treat in just a single session. It usually requires a series of repeated laser sessions to lighten the port wine stain. Most children undergoing laser treatment will require some form of sedation, local and/ or general anaesthesia. Importantly, parents and healthcare personnels should be aware that treatment for port wine stain is available (although at limited centres in Malaysia). Early referral to paediatric dermatologists is essential for diagnosis, counselling, discussion and available options of treatment.
Figure 6: Before (left) and after (right) a series of treatments with pulse dye laser [7]
Table 1: Summary of salmon patch and port wine stain [4]
What does it look like? |
Does it need to be treated? |
|
Salmon Patch |
|
|
Port Wine Stain
|
|
|
Parents who notice any birthmarks on their newborn babies are advised to talk to their paediatrician; or seek early consultation with a paediatric dermatologist.