Hemangiomas(birthmarks):

Hemangiomas are skin marks that can be flat or raised, with regular or irregular borders. They appear in children before or shortly after birth in different colors such as brown, purple, red, light blue, pink, and red. Most hemangiomas are not harmful and many of them regress spontaneously. Hemangiomas may be associated with some medical issues.

Causes of Hemangiomas:

There is no specific cause for hemangiomas, and there is no evidence that they result from anything done during pregnancy. There is no clear underlying cause, although some types may be hereditary in some families.

Types of Hemangiomas:

We have two main types of hemangiomas:
1- Vascular Hemangiomas: Occur when blood vessels fail to form properly or when a part of them is too large or wider than usual.
2- Pigmented Hemangiomas: Result from an overgrowth of cells that produce pigment (melanin) in the skin.

Common Vascular Hemangiomas:

1- Strawberry Hemangiomas: Also known as angel kisses or salmon patches, they are most commonly seen on the forehead, eyelids, nose, upper lip, back of the head. They become prominent when the child cries and usually disappear on their own by the age of one or two, sometimes persisting until puberty.
2- Cavernous Hemangiomas: Can be superficial (affecting the skin surface and called strawberry marks) or deep (located under the skin surface) and compound when they affect both layers together. Superficial hemangiomas appear slightly raised and light red, while deep hemangiomas appear blue as they involve blood vessels in deeper layers of the skin. Cavernous hemangiomas usually appear within a few days or weeks after birth, grow rapidly during the first six months, then regress and disappear within 5 to 10 years. Large hemangiomas may leave irregular skin formations that can be corrected through surgery. The most common locations for birthmarks are the head and neck, but they can appear anywhere on the body and may cause problems if located near the eyes, airways, or feeding areas.
3- Port-Wine Stains: Skin marks that resemble spilled wine, often appearing on the face, neck, and arms. They grow with the child's growth and may take different shapes. They darken over time and do not disappear on their own like other vascular hemangiomas. They require special monitoring, especially those located near the eye or face in general (the doctor may request further investigations such as MRI scans).

Pigmented Hemangiomas:

1- Café-au-lait Spots: Named after their color resembling a mixture of coffee with milk. Their number increases with age, so it is advisable to consult a doctor when there are 6 spots or more. An increased number may indicate neurofibromatosis (abnormal growth of nerve tissues due to a genetic cause).
2- Mongolian Spots: Flat grayish-blue spots usually appearing on the lower back or buttocks, more common in individuals with darker skin tones. They often fade without leaving traces by school age.
3- Moles: Congenital or acquired skin marks with a brown color. Those present since birth are called birthmarks. Moles appear in most people at some point in their lives and can continue throughout life. Moles can be flat or raised, brown or black, and may have hair growing from them. They usually pose no threat, but large moles may carry a risk of developing into skin cancer (melanoma).

Treatment:

Most hemangiomas resolve on their own. Some port-wine stains and cavernous hemangiomas may be disfiguring for the child and have psychological and social effects, so they should be managed.
Large cavernous hemangiomas can be treated by injecting certain substances directly into them, and laser therapy can help eliminate port-wine stains in affected children. Laser treatment is also used for café-au-lait spots but they often recur.
As for moles, large ones can be removed surgically, especially giant congenital moles that may be disturbing to the patient.
It is important to first consult a doctor to determine the type of hemangioma and provide necessary information about it. Seek immediate medical attention if the hem

angioma bleeds, causes itching, or becomes infected.
If a vascular hemangioma bleeds, clean the wound with water and soap and apply sterile gauze to stop the bleeding. Finally, reassure your child that the hemangioma was present at birth and that they are beautiful in all cases, and try not to avoid answering their questions.