Skin is just like the humans who wear it: It's not perfect. If everything went as planned, the body would produce just enough melanin and blood vessels would behave.

But that's not the case. There are birthmarks and other pigmentation disorders that affect many people. We've included some of the most common abnormalities here.

Remember: never self-diagnose! If you think you have one of these skin pigmentation abnormalities, make sure you visit a physician to receive an official diagnosis.

Birthmarks

As might be expected, this type of abnormal skin coloration will appear at birth or in just a few weeks following birth. It's important to remember that most birthmarks are non-cancerous, though a physician should examine your child if he or she is born with abnormally colored skin or develops birthmarks shortly after birth. Certain birthmarks described below can pose health risks.

Pigmented Birthmarks

The discoloration of the skin will appear smooth and flat. These spots are known by several names, including Mongolian spots -- bruised or bluish in color, typically appearing on buttocks; cafe-au-lait spots -- light brown; and typical moles, which are also called nevi. Moles should be monitored for bleeding, color, shape or size changes, or itching.

Macular Stains

These appear anywhere on the body, appearing as mild red marks, but they are not elevated. Macular stains are the most common type of vascular (from blood vessels) birthmark. These marks can come in two forms:

• Angel's kisses may appear on the forehead and eyelids, but will typically disappear after age 2.
• Stork bites will appear on the back of the neck and can last into adult years.

Because these marks are often mild, there is no treatment necessary.

Hemangioma

Hemangiomas are caused by many tiny blood vessels bunched together and vary in severity. Typically, this birthmark can be just that, a mark, or it can grow larger and larger until treated. Hemangiomas can grow very rapidly through the first year of a child's life.

There are two types of hemangiomas: strawberry hemangiomas, which are slightly raised, red birthmarks and can appear anywhere on the body; or cavernous hemangiomas, which are a deeper birthmark characterized by a bluish color.

Most hemangiomas will go away on their own; roughly 50% resolve by age five, 70% by age seven and 90% by age nine.

Reasons to treat hemangioma include problems with functions (such as sight, eating, hearing or defecation), ulceration or pain. Hemangiomas can be treated in different ways, each of which carries its own risks.

Corticosteroid medication, which can be injected or taken orally, is one option for treating hemangiomas. Risks associated with corticosteroid medication include high blood pressure, high blood sugar, poor growth, or cataracts. If corticosteroids fail, there are other medications that may be an option.

Certain hemangiomas can also be treated with lasers to stop them from growing. Risks associated with that treatment include ulceration and scarring.

In some cases, a hemangioma can also be removed with surgery. Other times, a combination of these approaches is the most beneficial treatment.

Port-wine Stains

Port wine stains are caused by abnormal development of blood vessels (capillaries) and last a lifetime. The port-wine stain (also known as nevus flammeus) appears as a flat, pink, red or purple mark, and occurs on the face, trunk, arms, or legs.

If you or your child has a port wine stain present on eyelids, this is thought to pose an increased risk of glaucoma, an eye disease associated with increased pressure in the eyes that can lead to blindness if it's not treated.

Physicians have tried many ways to treat port wine stains, including radiation, tattooing, freezing, dermabrasion, or sclerotherapy. Laser treatment is currently the only method that destroys capillaries in the skin without causing damage to the rest of the skin.

Port wine stains may be seen in certain medical disorders, including Sturge-Weber Syndrome, with symptoms that include port wine stains on the face, vision problems, convulsions, mental retardation and perhaps even paralysis; and Klippel-Trenaunay Syndrome which may include symptoms of many port wine stains, varicose veins and/or too much bone and soft tissue growth. Each of these syndromes is very rare.

Skin Pigmentation Disorders

Albinism

Albinism, an inherited disorder, is caused by the absence of the pigment melanin and results in no pigmentation in skin, hair, or eyes. In albinos, their body has an abnormal gene, which restricts the body from producing melanin. There is no cure for albinism, and individuals should use a sunscreen at all times because they are much more likely to get sun damage and skin cancer. This disorder can occur in any race.

Melasma

Melasma (also known as chloasma) is characterized by tan or brown patches on the cheeks, nose, foreheard, and chin. Although this condition is typically termed the "pregnancy mask," men can also develop this condition. Melasma may go away after pregnancy but, if it persists, can be treated with certain prescription creams and some over the counter skin care products. Remember to consult your physician or dermatologist for a proper diagnosis of this condition before you choose to treat it yourself. If you have melasma, use a sunscreen at all times because sunlight will worsen your condition.

Pigmentation Loss As a Result of Skin Damage

If you've had a skin infection, blisters, burns or other trauma to your skin, you may have a loss of pigmentation in the affected area. The good news with this type of pigment loss is that it's frequently not permanent, and cosmetics can be used to cover the area.

Vitiligo

Vitiligo is a pigmentation disorder in which melanocytes (the cells that make pigment) are destroyed. As a result, white patches of skin appear on different parts of the body. The cause of vitiligo is not known, but some possible causes include physical trauma or certain diseases such as diabetes. There is no cure for vitiligo, but there are several treatments, including psoralens (light-sensitive drugs) used in combination with ultraviolet A light treatment.

Reviewed by the doctors at The Cleveland Clinic, Department of Plastic Surgery.
Edited by Cynthia Haines, MD, April 2005.

Portions of this page ©The Cleveland Clinic 2000-2003.

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