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To understand how birthmarks are treated with lasers, it helps to first understand what makes up a birthmark. Birthmarks generally fall into one of two broad categories: 1) red (vascular) or 2) brown (pigmented). Although seldom life-threatening, a large birthmark can have a tremendous negative psychological effect on a child. Additionally, some vascular birthmarks can impinge on vital structures such as the nose, eyes, or lips, which can result in a child’s delayed development and even permanent damage.

The most common birthmark found on babies is the hemangioma or strawberry. These are non-cancerous tumors composed of numerous blood vessels. Hemangiomas appear in the first few weeks of life on about 1 out of every 10 infants. Girls are more commonly affected than boys.
The hemangioma tumor may start as a pinpoint-sized red dot. Within a few months, the hemangioma usually reaches its full size, which can be anywhere from one to several inches in diameter. Once it has fully developed (typically 10 to 12 months after birth), the tumor begins a prolonged period of shrinking.

In more than 50 percent of children with a hemangioma, the tumor has completely disappeared by the age of five. Seventy percent of children see their tumor clear up by their seventh birthday. If a child is not free of the hemangioma by the age of 10, it is unlikely that the birthmark will go away on its own.
Port-wine stains are also vascular birthmarks but are only seen in about three to five children out of every 1,000 born in North America. These birthmarks differ significantly from hemangiomas. They start as a thin mat of abnormally large capillaries clustered together in the upper part of the dermis just beneath the surface of the skin. Although pale, they are usually evident at birth, and are most often located on the face or neck.

As the child grows, the port-wine stain grows proportionately and deepens in color. It may also suddenly expand because of changes in the circulatory system or hormonal fluctuations such as those that occur during puberty.

Over the years, port-wine stains continue to darken and thicken. At the end of childhood, the birthmark is typically bright red. In early adulthood, it may appear deep claret. By middle age, it is usually deep purple, and may have developed a thickened, pebbly texture. These birthmarks often distort facial features and can interfere with the way the lips, nose, or eyes function.

Unlike port-wine stains and strawberries, which are vascular in nature, brown birthmarks (often called caf-au-lait spots) are the result of pigment abnormalities, the cause of which is unknown. Up to 10 percent of all babies born will have these tan-colored birthmarks.

Melanocytes, the specialized cells that produce the skin pigment melanin, are located in the lowest (basal) layer of the epidermis (the upper layer of the skin). Melanocytes produce melanin inside microscopic packages called melanosomes. As melanocytes migrate to the surface of the epidermis, they transfer the melanin-laden melanosomes to other skin cells and to the hair follicles. This is what gives people their individual skin and hair color. Caf-au-lait birthmarks are composed of abnormal, often unusually large, melanosomes. These birthmarks range in size from less than one inch to about eight inches in diameter.

Lasers affect birthmarks by emitting an intense colored light that is absorbed by the targeted cells. Since vascular and pigmented birthmarks are different colors, they are treated with different colored laser light.

Before the introduction of the argon laser in the early 1970s, physicians had little success in treating vascular birthmarks without leaving disfiguring scars or causing serious side effects. Unfortunately, the argon laser also had the potential to leave scars, particularly when used to treat children. In the mid-1980s, the flashlamp-pumped pulsed dye laser became commercially available. It was developed specifically to treat children’s port-wine stains.

The pulsed dye laser is tuned to penetrate just far enough into the skin to reach the deeper components of vascular birthmarks. The laser beam is flashed on and off electronically. This enables it to deliver the maximum energy needed to instantly incinerate red blood cells and then shut off before surrounding normal tissue is affected. Both port-wine stains and hemangiomas can be safely and effectively treated with the pulsed dye laser.

Caf-au-lait birthmarks are treated with a number of lasers that have been specifically designed to selectively destroy melanin-containing cells. The safest and most effective of these lasers employ a rapid-fire shuttering system, called Q-switching, that flashes the laser beam on and off in nanosecond bursts. Like a pulsed dye laser, Q-switching ensures that adjacent tissue is not burned by the laser’s heat. The ruby laser, the alexandrite laser, and the Nd:YAG laser are the three most common Q-switched lasers used to treat pigmented birthmarks.

Birthmarks can be treated with the laser at any point in life. However, most physicians agree that the sooner a child has a disfiguring birthmark removed, the better it is for both the child and parent.

Removing a red or brown birthmark usually requires multiple treatments. Laser treatment is not particularly painful, and there is no recuperation needed after treatment. Most patients describe the procedure as feeling as if someone is snapping a rubber band rapidly against their skin. As you can imagine, most children do not willingly tolerate the procedure. This is difficult for most parents. However, if treated at a young age, children will not remember the procedure. More importantly, they will never have to deal with their birthmark, be self-conscious about their appearance, or feel alienated by their peers.

In summary, if you have a vascular or pigmented birthmark and would like it removed, you should consult an experienced laser surgeon. Find out his or her success rate for removing or improving birthmarks similar to yours. If your child has a vascular birthmark, it is essential that he or she be examined by a physician as soon as possible. Certain vascular birthmarks are associated with underlying abnormalities of the brain and eye.

With today’s advanced laser treatment of birthmarks, there is no reason for anyone to spend a lifetime dealing with the discomfort and embarrassment so often caused by a disfiguring birthmark. As with any surgical procedure, there are risks of complications and total removal of the birthmark cannot be guaranteed. However, in almost all cases, patients report a high level of satisfaction with laser treatment of birthmarks.

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