Skin Conditions: Pigmented Birthmarks

Written by Felicia Wilson
Medically Reviewed by Zilpah Sheikh, MD on September 18, 2025
7 min read

Birthmarks are colored skin spots that either are present at birth or develop shortly after birth. Birthmarks can be of many colors, including brown, tan, black, pale blue, pink, white, red, or purple. Some birthmarks are only colorations of the surface of the skin; others are raised above the surface of the skin or extend into the tissues under the skin. 

The cause of most birthmarks is unknown. Most birthmarks are not inherited. Many folk tales and myths exist about the causes of birthmarks, but none of these stories have been proven to explain the true causes of birthmarks.

Most birthmarks need no treatment. They often fade as a child grows older. But some birthmarks may need treatment because of their location. For example, a raised birthmark near a child's eye may interfere with their ability to see. In rare cases, birthmarks are associated with other conditions, such as growths on the liver, lungs, stomach, or intestines.

There are two main categories of birthmarks: red birthmarks and pigmented birthmarks.

Red birthmarks are colored, vascular (having to do with blood vessels) skin markings that form before or shortly after birth. Pigmented birthmarks are skin markings that are present at birth. Their color ranges from brown or black to bluish or blue-gray.

Macular stains

These are a type of birthmark that may appear anywhere on the body as light red, flat marks. Macular stains are the most common type of vascular (developing from blood vessels) birthmark. These marks can come in two forms, known commonly as angel's kisses or stork bites.

  • Angel's kisses may appear on the forehead and eyelids but will typically disappear early in childhood.
  • Stork bites will appear on the back of the neck and can last into adult years.

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

Hemangioma

Hemangiomas are caused by many tiny blood vessels bunched together and appear as raised areas on the skin. They can vary in size from a few millimeters to several centimeters. Hemangiomas can grow very rapidly through the first year of a child's life. Most hemangiomas will slowly go away in a few years.

Most hemangiomas will go away on their own; roughly 50% resolve by age 5, 70% by age 7, and 90% by age 9.

Some hemangiomas may be near the eye, nose, lips, or genitalia. Hemangiomas in these sensitive areas sometimes need to be treated so they don't interfere with seeing, breathing, eating, or defecating. These hemangiomas can also break down or ulcerate easily, becoming very painful. Reasons to treat a hemangioma include problems with functions (such as seeing, eating, hearing, or defecating), 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 called selective beta-blockers, such as atenolol, nadolol, and propranolol, that may be an option. Topical timolol is also used, especially for smaller hemangiomas.

Certain hemangiomas can also be treated with lasers to stop them from growing. The VBeam laser is FDA-approved, pulsed dye laser technology, and it has been successful at treating early superficial hemangiomas. Risks associated with that treatment include pain, 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 can occur on the head, 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, which can lead to blindness if not treated.

Doctors have tried many ways to treat port-wine stains, including radiation, tattooing, freezing, dermabrasion, or sclerotherapy. Laser treatment is the preferred treatment because it is 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, intellectual disability, 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. Both these syndromes are very rare.

Types of pigmented birthmarks

Congenital melanocytosis, previously called Mongolian spots,usually are bluish and look like bruises. They often appear on the buttocks and/or lower back, but they sometimes also appear on the trunk or arms. The spots are seen most often in people who have darker skin.

Pigmented nevi (moles) are growths on the skin that usually are flesh-colored, brown, or black. Moles can appear anywhere on the skin, alone or in groups. Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. Moles may darken after exposure to the sun, during the teen years, while taking some birth control pills, and during pregnancy.

Congenital nevi are moles that are present at birth. These birthmarks have a slightly increased risk of becoming skin cancer, depending on their size. Larger congenital nevi have a greater risk of developing skin cancer than do smaller congenital nevi. All congenital nevi should be looked at by a health care provider and any change in the birthmark should be reported.

Cafe au lait spots are light tan or light brown spots that are usually oval in shape. They usually appear at birth but may develop in the first few years of a child's life. Cafe au lait spots may be a normal type of birthmark, but the presence of many cafe au lait spots larger than a quarter may occur in neurofibromatosis (a genetic disorder that causes abnormal cell growth of nerve tissues) and other conditions.

The cause of pigmented birthmarks is not known. But the amount and location of melanin (a substance that determines skin color) determines the color of pigmented birthmarks.

Symptoms of birthmarksinclude skin that is abnormally dark, light, bluish, brown, black, or blue-gray. Discolorations of the skin may vary in size and can be smooth, flat, raised, or wrinkled. Pigmented birthmarks may increase in size, change colors, become itchy, and occasionally bleed. If they do, they should be seen by a dermatologist as they may need a biopsy.

In most cases, health care professionals can diagnose birthmarks based on the appearance of the skin. If a mole displays potentially cancerous changes, a biopsy may be done.

In most cases, no treatment is needed for the birthmarks themselves. But when birthmarks do need treatment, the treatment varies based on the kind of birthmark and its related conditions.

Large or prominent moles that affect appearance and self-esteem may be covered with special cosmetics. Moles can also be removed surgically.

Since there is an increased risk of skin cancer in congenital nevi, see a doctor if you notice a change in color, size, or texture of a mole or other skin lesion. Also, see a doctor right away if there is any pain, bleeding, itching, inflammation, or ulceration of a congenital mole or other skin lesion.

There is no known way to avoid birthmarks. People with birthmarks should use a good quality sunscreen with an SPF of 30 or higher when outdoors in order to avoid other problems.

Birthmarks are common and usually harmless. They come in different colors and forms — some flat, some raised — and can appear at or shortly after birth. Most don't need treatment and fade over time, but a few might need to be removed by a doctor.

There are two main types of birthmarks: pigmented (like moles) and vascular (like hemangiomas or port-wine stains).

Some birthmarks can signal health issues, so it's important to monitor changes. Go see a doctor if you notice anything.

How do you remove birthmarks?

If you have a birthmark and you want it removed, go to your doctor. There are many ways to remove it, including laser or surgical removal, cryotherapy (freezing and removing the area), or using cortisone shots to lighten the area.

What is the difference between pigmentation and birthmarks?

 A pigmented birthmark happens when you have an overgrowth of pigment cells (melanocytes). These birthmarks will appear darker than your regular skin color. 

A vascular birthmark happens when blood vessels don't form correctly before birth. They are usually red in color.

Can pigmented birthmarks disappear?

Yes, some birthmarks can disappear or fade with time. They include cafe au lait spots and some moles. Other birthmarks such as port-wine stains are permanent. You can consider having them removed by a health care specialist.

Are birthmarks genetic?

Some birthmarks can be linked to genetics. Generally, though, experts don't know exactly what causes them.