Skip to main content

Paediatric condition

Birthmarks in children, the marks that fade, the ones that treat, and the ones that signal more.

Most birthmarks are harmless and fade on their own. A minority need propranolol, pulsed dye laser or surgery, and a few point to a syndrome worth screening for.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against BAD, GOSH, NICE and peer-reviewed paediatric dermatology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK paediatric practice including propranolol for infantile haemangioma and early PDL for port-wine stains.

Key facts

Birthmarks at a glance.

The essentials, in plain English: the two families of birthmark, the treatments that matter, and the syndromes worth ruling out.

  • What they are

    Vascular or pigmented skin marks present at birth or appearing in early infancy, ranging from harmless to syndromic.

  • Vascular

    Infantile haemangioma, congenital haemangioma, port-wine stain, venous and lymphatic malformations, naevus simplex.

  • Pigmented

    Congenital melanocytic naevi, cafe au lait macules, dermal melanocytosis, naevus spilus and naevus of Ota or Ito.

  • First-line drug

    Oral propranolol 2 to 3 mg/kg/day is the standard treatment for problematic infantile haemangioma.

  • Laser of choice

    Pulsed dye laser (PDL) started in infancy gives the best long-term outcome for port-wine stains.

  • Syndromic clues

    Segmental facial haemangioma, V1 port-wine stain and multiple cafe au lait spots all warrant syndrome screening.

Why this guide matters

Reassurance where it fits, action where it counts.

Birthmarks are common. The job is to sort the everyday from the syndromic, and to act early when early action matters.

  • Most birthmarks fade or settle

    Naevus simplex, small haemangiomas and dermal melanocytosis usually resolve without treatment.

  • A few need early treatment

    Ulcerated, periocular, airway and large facial haemangiomas do best with propranolol started in infancy.

  • A minority point to a syndrome

    V1 port-wine stain, segmental haemangioma, and multiple cafe au lait deserve a syndrome screen.

How the diagnosis is made

From first look to a clear plan.

The steps a UK paediatric dermatologist will usually follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Dermatological examination

    Full skin check with parental history: onset, growth pattern, colour change, ulceration and any family history of vascular anomalies.

  2. 02

    Assessing

    Photograph and measurement

    Serial clinical photography and measurement track proliferation, involution and treatment response over months.

  3. 03

    Assessing

    Associated feature screen

    Look for segmental distribution, cafe au lait number and size, V1 involvement, midline lesions and satellite naevi.

  4. 04

    Confirming

    Syndrome screen

    Cafe au lait suggests NF1; V1 port-wine stain suggests Sturge-Weber; segmental facial haemangioma suggests PHACES or LUMBAR.

  5. 05

    Confirming

    Cardiac and airway assessment

    Pulse oximetry, echocardiogram and airway review for large or segmental haemangiomas, especially in the beard distribution.

  6. 06

    Referring

    Imaging when indicated

    MRI brain and orbits for suspected Sturge-Weber, PHACES or large lumbosacral lesions; MR angiography for complex malformations.

  7. 07

    Referring

    Ophthalmology and neurology

    Ophthalmology for periocular lesions and V1 port-wine stains (glaucoma screen); neurology for suspected leptomeningeal involvement.

Typical timeline: a first specialist visit to a settled plan in weeks, with reviews over months and years.

Types

What the different birthmarks look like.

Vascular, pigmented and epidermal groups sit behind the everyday names: strawberry marks, stork marks, port-wine stains, cafe au lait and moles.

  • Infantile haemangioma

    Appears in the first weeks, proliferates for 6 to 12 months and slowly involutes over 5 to 10 years.

  • Congenital haemangioma

    Fully formed at birth: RICH involutes rapidly, NICH does not involute, PICH partially involutes.

  • Port-wine stain

    A persistent capillary malformation that deepens and thickens with age, often on the face or limbs.

  • Venous or lymphatic malformation

    Soft, compressible swellings or cystic masses (cystic hygroma) that grow with the child.

  • Naevus simplex

    Stork mark, salmon patch and angel kiss: pink patches on the nape, eyelids or forehead that fade over months to years.

  • Congenital melanocytic naevus

    Brown or black pigmented patch present at birth: small, medium or large and giant (over 20 to 40 cm projected adult size).

  • Cafe au lait macules

    Flat, coffee-coloured patches: six or more (>5 mm prepubertal or >15 mm postpubertal) raise the possibility of NF1.

  • Red flag - syndromic pattern

    Segmental haemangioma, V1 port-wine stain, multiple cafe au lait or large CMN with satellites all need specialist review.

Treatment

How birthmarks are treated in the UK.

Observation for most, propranolol for problematic haemangiomas, pulsed dye laser for port-wine stains, and specialist MDT care for syndromic disease.

  • Active observation

    For most naevus simplex, small haemangiomas and dermal melanocytosis: photograph, measure and let natural resolution occur.

  • Oral propranolol

    First-line for problematic infantile haemangioma at 2 to 3 mg/kg/day: ulcerated, periocular, airway, segmental or large facial lesions.

  • Topical timolol 0.5%

    Gel-forming solution for superficial infantile haemangiomas: a gentler option when systemic beta-blockade is not warranted.

  • Pulsed dye laser (PDL)

    The standard treatment for port-wine stains and residual haemangioma telangiectasia: start early, expect multiple sessions.

  • Sclerotherapy

    For venous and lymphatic malformations: image-guided injection to shrink abnormal vessels or cystic spaces.

  • Surgical excision

    Selective removal for congenital melanocytic naevi, non-responsive haemangiomas and cosmetically or functionally significant lesions.

  • Syndrome-directed care

    Anti-epileptics and glaucoma management for Sturge-Weber; MRI surveillance and genetic counselling for NF1; cardiac and airway plans for PHACES.

  • Psychosocial support

    Charities such as Changing Faces, Birthmark Support Group UK and Butterfly Skin help children and families adjust and thrive.

For port-wine stains, see our dedicated guide to pulsed dye laser for birthmarks.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or paediatric dermatologist knows your child and can say which parts apply. If in doubt, ask for a review.

  • British Association of Dermatologists (BAD). Patient information leaflets on haemangiomas, port-wine stains and congenital melanocytic naevi.

  • Great Ormond Street Hospital (GOSH). Paediatric dermatology and vascular anomalies clinical guidelines.

  • NICE Clinical Knowledge Summaries. Haemangioma and neurofibromatosis type 1.

  • International Society for the Study of Vascular Anomalies (ISSVA). Classification of vascular anomalies (2018, updated).

Red flags

When a birthmark needs urgent attention.

Most birthmarks are manageable in the community. These are the patterns that are not, and that deserve early specialist input.

  • Periocular haemangioma

    Any lesion near the eye risks visual axis obstruction and amblyopia: urgent ophthalmology and paediatric dermatology input needed.

  • Airway (beard) haemangioma

    Segmental haemangioma over the chin, jaw and neck raises the risk of airway involvement: ENT and paediatric assessment required.

  • Ulcerated haemangioma

    Painful, bleeding or infected ulceration needs prompt wound care and often propranolol to accelerate involution.

  • V1 port-wine stain

    Forehead or eyelid distribution raises Sturge-Weber risk: MRI brain and ophthalmology review for glaucoma and seizures.

  • Large or giant CMN with satellites

    Melanoma risk and neurocutaneous melanosis: paediatric dermatology, genetics and imaging as clinically indicated.

  • Segmental facial haemangioma

    Consider PHACES syndrome: posterior fossa, arterial, cardiac, eye and sternal anomalies; MRI and echocardiogram indicated.

  • Lumbosacral haemangioma

    Midline lesion suggests LUMBAR (spinal dysraphism and urogenital anomalies): spinal MRI and urology review.

  • Six or more cafe au lait

    Especially with axillary freckling or Lisch nodules: NF1 diagnostic criteria and genetics referral.

  • Rapidly changing pigmented lesion

    Any change in colour, size, shape or symptoms within a CMN warrants urgent dermatology review to exclude melanoma.

Living with it

A steady plan for children and families.

Four things that make the biggest difference year to year: reassurance where it fits, early laser for port-wine stains, daily sun care and peer support.

A quiet reminder

Photograph, measure and review.

A phone photo taken every few months is one of the most useful things a parent can bring to a clinic appointment.

  1. 01 Reassurance

    Most fade or settle

    Naevus simplex, infantile haemangiomas and dermal melanocytosis usually resolve without treatment: photograph and review.

  2. 02 Early laser

    Start PDL early for port-wine stains

    Beginning pulsed dye laser in infancy gives the lightest long-term result: multiple sessions are the norm.

  3. 03 Sun care

    Daily sunscreen for pigmented lesions

    UV protection reduces darkening of congenital melanocytic naevi and pigmentation after laser or surgery.

  4. 04 Support

    Talk about how it feels

    Changing Faces and Birthmark Support Group UK offer resources for children, siblings and parents.

Frequently asked

Everything parents ask about birthmarks.

Quick answers on haemangiomas, port-wine stains, congenital naevi, syndromes and UK specialist care.

  • What are the main types of birthmark?

    Birthmarks fall into two broad groups. Vascular birthmarks (infantile and congenital haemangiomas, port-wine stains, venous and lymphatic malformations, and naevus simplex) come from blood or lymph vessels. Pigmented birthmarks (congenital melanocytic naevi, cafe au lait macules, dermal melanocytosis, naevus spilus, naevus of Ota or Ito) come from pigment cells. Sebaceous and epidermal naevi are a smaller third group.

  • Will my child’s haemangioma need treatment?

    Most infantile haemangiomas involute on their own over 5 to 10 years and need only photograph-and-review. Treatment with oral propranolol (2 to 3 mg/kg/day) or topical timolol 0.5% gel is offered when the lesion is ulcerated, near the eye or airway, segmental, large on the face, or functionally troublesome. Residual telangiectasia can later be softened with pulsed dye laser.

  • What is a port-wine stain and how is it treated?

    A port-wine stain is a capillary malformation: a persistent pink or red patch that deepens and thickens with age. Pulsed dye laser (PDL) started in infancy gives the best long-term lightening and usually needs multiple sessions. When the port-wine stain involves the forehead or upper eyelid (V1), Sturge-Weber syndrome is screened for with MRI and ophthalmology.

  • What is Sturge-Weber syndrome?

    Sturge-Weber syndrome is a rare neurocutaneous condition linked to V1 port-wine stains. It can involve glaucoma, a leptomeningeal arteriovenous malformation, seizures and hemiparesis. Screening includes ophthalmology from birth, MRI brain and neurology review. Treatment addresses eye pressure, seizures and, when needed, neurosurgical input.

  • When do congenital melanocytic naevi need surveillance?

    Small and medium CMN carry a low melanoma risk and are usually observed clinically with photographs. Large and giant CMN (projected adult size over 20 cm, or over 40 cm for giant) and CMN with multiple satellite lesions carry higher risk and can be associated with neurocutaneous melanosis: paediatric dermatology, genetics, MRI (when indicated) and long-term surveillance are the standard.

  • Where can we get specialist care and support in the UK?

    Specialist paediatric dermatology and vascular anomaly MDT services are based at Great Ormond Street, Alder Hey, Birmingham Children’s, Bristol and Nottingham Children’s hospitals. Charities such as Changing Faces, Birthmark Support Group UK and Butterfly Skin offer peer support, resources and school-liaison advice for children and families.

Related content

Keep reading.