Congenital Skin Conditions

Question 1

What are the two type of vascular birthmarks?

Answer 1

1. Vascular tumours - strawberry haemangioma or capillary haemangioma
2. Vascular malformations - stork bite or port wine stain

Question 2

What is the most common cause of vascular birthmarks?

Answer 2

Infantile haemangioma

Question 3

What is this a presentation of?
Rarely at birth, small red or blue lump at 2-4 weeks of age. Superficial bright red, irregular, raised lesions. Commonly affect head and neck.

Answer 3

Infantile haemangioma

Question 4

What is this a presentation of?

Irregular, pink, macular lesion commonly on the forehead, eyelids or back of the neck. Present from birth.

Answer 4

Stork bite

Question 5

What is this a presentation of?
Often unilateral, affecting head and neck. At birth it is flat, irregular, and red. With age, becomes deeper purple colour, bumpy and thickened.

Answer 5

Port wine stain

Question 6

What is the management for infantile haemangiomas?

Answer 6

1. Grow rapidly until 6 months, stasis, then involution (90% disappear by 7 years)
2. PO propranolol if compromising airway/periorbital.

Question 7

What is the management for stork bites?

Answer 7

Fades by 18 months, no treatment if of no consequence.

Question 8

What is the management of port wine stains?

Answer 8

Associated with Struge-Weber syndrome if around the eye and forehead. Consider laser treatment under dermatology if causing significant distress.

Question 9

What are pigmented birthmarks?

Answer 9

Excessive skin pigmentation with melanin

Question 10

What are the types of pigmented birthmarks?

Answer 10

1. Mongolian blue spot (congenital dermal melanocytosis)
2. Café-au-lait spots
3. Congenital melanocytic naevi (moles)

Question 11

What is the cause of Mongolian blue spots and café-au-lait spots?

Answer 11

1. Persistence of melanocytes in the dermis during intrauterine development.
2. Localised increase in melanin concentrations.

Question 12

What is this a presentation of?

Flat, blue grey lesions, commonly on the buttocks or lower back, present at birth.

Answer 12

Mongolian blue spots

Question 13

What is this a presentation of?
Light to brown dark coloured macular lesions, vary in size and occur anywhere, may present at birth but more commonly early childhood.

Answer 13

Café-au-lait spots

Question 14

What is the management for Mongolian blue spots, café-au-lait spots, and congenital melanocytic naevi?

Answer 14

1. Fade by adolescence, no investigations or treatments needed.
2. Benign if isolated, multiple are associated with neurofibromatosis type 1.
3. No intervention needed unless over 20 cm, then monitoring needed.