News About Birthmarks and Port Wine Stains

Vascular birthmarks such as hemangiomas and port wine stains are often shocking to new parents. It is understandable. Years ago babies born with such disfiguring vascular birthmarks were met with a hands-off approach to treatment. But the medical community is switching its tact, from watchful waiting to early intervention, diagnosis and often even treatment. The turnaround is based on a clearer understanding of the medical and emotional consequences wrought by these congenital defects, and the advances in technologies that are well-suited to treat even infants comfortably and safely.

October 26, 2004 -- A NEW APPROACH TO TREATING TROUBLING BIRTHMARKS: Leading dermatologist Joshua Fox, MD, discusses the switch from watchful waiting to early intervention

Advanced Dermatology PC, NY, NY 2004 Since the early 1900s, babies born with such disfiguring vascular birthmarks as hemangiomas and port wine stains and their parents have traditionally been met with a hands-off approach to treatment. But the medical community is slowly switching its tact, from watchful waiting to early intervention, diagnosis and often even treatment. The turnaround is based on a combination of a clearer understanding of the medical and emotional consequences wrought by these congenital defects, and the advances in technologies that are well-suited to treat even infants comfortably and safely.

According to Dr. Joshua Fox, a leading NY-area dermatologist and founder of Advanced Dermatology P.C. and The Center for Laser and Cosmetic Surgery, nearly 40,000 children in the U.S. can benefit from surgical intervention for their birthmarks each year. The good news is that both anesthesiology, microembolization and laser technology have been advanced significantly in recent years, so we can treat children at a much younger age more effectively and comfortably than ever before, Dr. Fox explains. Thats important, because while the term birthmark can seem innocuous enough, -- hemangiomas and port wine stains can compromise a childs healthy growth and development, and can sometimes signal more serious medical problems.

For instance, Dr. Fox notes, strawberry hemangiomas -- so named because of their pinkish hue and their typical size and shape -- are actually benign tumors that usually grow on the skin. Depending upon their location, strawberry hemangiomas can interfere with feeding, breathing, vision or proper physical development. Some hemangiomas grow inward, which can put vital organs at risk. Whats more, as with all tumors, hemangiomas require a rich blood supply to survive. As babies become more mobile, an injury to the hemangioma can cause excessive bleeding and can result in an emergency room visit for cauterization. More powerful vascular lasers with larger spot sizes, better cooling devices and more wavelengths and varying treatment times have allowed for clearing of port wine stain in half the time of a decade ago with better long term results. Plus, those that were previously resistant to treatment are now responding and patients and their families are thrilled. Also some hemangiomas respond to medication orally and intralesionally including microembolization.

In rare instances, the venous system within the hemangioma becomes so large and demanding that it saps a developing childs much-needed blood supply, taxing the heart and stunting normal growth. Perhaps most importantly, it creates psychological barriers and much social grief for parents and patients.

The new approach to hemangioma treatment includes consultation with a board-certified dermatologist who specializes in lasers as quickly as possible, to secure an early, accurate diagnosis to rule out associated complications and to establish regular monitoring periods. Yet, the medical evidence is clear: Almost 90% of hemangiomas do largely shrink on their own by adolescence, at which time laser or cosmetic surgery can address any lingering scarring emaining lession. Dr. Fox feels that early treatment lessens this residual scarring, discoloration and or texture changes. However, new surgical techniques, along with advances in laser and cauterization technologies, have made the procedure to remove hemangiomas, which have a high risk of excessive bleeding, safer for those children who require it.

Port wine stains, on the other hand, never fade. In fact, Dr. Fox points out, these flat, pinkish splotches on the skin at birth are actually a vascular network right below the skins surface of malformed capillaries that often get larger, deeper and darker purple as the child grows. Port wine stains have traditionally been more challenging to treat, because they are essentially permanent congenital defects. Even as we learn new ways to destroy the capillaries, they simply redevelop. These marks can also be a harbinger of medical troubles. Children born with port wine stains on their eyelids, foreheads and/or scalps are usually given an MRI exam during the neonatal period, because each year about 5% of children with a port wine stain in this general location are diagnosed with Sturge-Weber Syndrome, which can cause glaucoma and developmental delays.

Yet, the continued perfecting of laser treatments including the newer more powerful. Pulse-Dye Laser is giving new hope to patients with port wine stains. Though most stains requires 6 to 8 treatments over the course omonths to years and sometimes touch ups later in life, about 75% of patients will experience a lightening of the stain that is significant enough to make a difference in their emotional health. Thats perhaps the biggest piece of the puzzle surrounding vascular birthmarks, Dr. Fox says. The evidence is clear that, as early as the preschool years, these disfiguring birthmarks can have lasting negative effects on a childs normal emotional development and self esteem as well as on the parents.

Vascular birthmarks are often a shock to new parents, Dr. Fox adds, And this is understandable. But while many mothers blame themselves for their childs birthmarks, parents can rest assured that there is no medical evidence that expectant mothers can prevent them, or that anything an expectant mother does during her pregnancy that causes them. Whats more, we are better able to address these birthmarks in a way that can reduce their medical and emotional effects than ever before, he adds.

Bio: Joshua L. Fox, M.D.
Joshua L. Fox, M.D. is a leading authority in the field of dermatology with an expertise in skin cancer, cosmetic surgery, and laser procedures. As an official spokesperson for the American Academy of Dermatology and the American Society of Dermatologic Surgery, Dr. Fox has been an expert resource on dermatologic topics for numerous television networks including ABC, CBS, CNN, NBC, Telemundo, talk shows, radio stations, newspapers and magazines. Dr. Fox has served on the board of the National Rosacea Foundation and has done clinical trials in both medical and laser therapy in Rosacea. He has received multiple research and clinical awards including recognition from Top Doctors, Who's Who, Journal of Dermatologic Surgery and Oncology, Community Service Award from the American Society of Dermatologic Surgery, the prestigious Husic Award as well certificates of recognition for service from multiple hospitals, civic, educational and community organizations. Dr. Fox has authored and presented papers of his research on lasers, cosmetic procedures, stretch marks, scars, skin cancer, bug bites, photosensitivity and various rashes.

As founder and director of Advanced Dermatology and The Center for Laser and Cosmetic Surgery, Dr. Fox and associates have expanded the practice to the one of largest in dermatology, laser & cosmetic surgery with more lasers than any hospital or dermatology practice on the eastern coast. Dr. Fox is a graduate of the New York University Medical Center of Skin and Cancer and has been on the advisory board of the Psoriasis Foundation and National Rosacea Foundation among others. He has also been a fellow of many societies including the International Academy of Cosmetic Surgery, International Academy of Cosmetic Dermatology, and the Society for Investigative Dermatology. Dr. Fox is the founder of the AAD Melanoma/Skin Cancer Prevention Program in Queens, New York since 1987. Dr. Fox has been Chief of Dermatology of several major teaching hospitals including Mt. Sinai Hospital of Queens and Jamaica Medical Center and is currently on the staff of ten NY area hospitals. Dr. Fox and Advanced Dermatology the Center for Laser & Cosmetic Surgery have been used as a resource center educating dermatologists, laser surgeons, & cosmetic surgeons and others about lasers, cancer and cosmetic surgery.

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