An in-depth examination of congenital birthmarks—including red, dark, Ota's, and Mongolian spots—reveals the risk of glaucoma that can cause blindness, along with safe laser treatment options to reduce their appearance.
"Birthmarks" are not just congenital identifying marks but can be overlooked health warning signs, especially "red birthmarks," which may be associated with glaucoma leading to vision loss. Understand the differences among birthmark types, care methods, and innovative laser treatments that help restore your skin's confidence.
Skin lesions present from birth, known as "birthmarks," are mainly found in two colors: red and dark. These have different causes and clinical courses as follows.
Caused by abnormal dilation of blood vessels, called port-wine stains in English, red birthmarks are mostly seen on the face—about 90%—usually on one side. They may appear on the cheek, forehead, or chin, with the cheek and one side of the forehead being the most common sites. Red birthmarks affect males and females equally, each accounting for 50%.
Resulting from pigment cell abnormalities, dark birthmarks come in various types, mostly found on one side of the face, such as the cheek or forehead, and are more common in females, about 80%.
Dark facial birthmarks are called “Ota's spots,” a term coined by Japanese doctors, commonly seen in Japanese, Thai, Korean, and Chinese people. Dark birthmarks found elsewhere on the body are called “Ito's spots.”
Birthmarks located on the sacral area or back are known as “Mongolian spots,” which typically fade by age 3 in about 97% of cases, leaving only 3% remaining without problems. These are commonly found among Asians.
Ota's and Ito's spots do not disappear on their own and tend to darken. About 60% of Ota's spots are present at birth, while 40% appear during adolescence, occurring more frequently in females.
With age, the abnormal blood vessels dilate further, causing the birthmark area to darken or thicken, leading to rough, raised skin, which mainly affects appearance. Importantly, about 30% of these patients may also develop glaucoma caused by increased eye pressure that compresses the optic nerve, potentially leading to blindness if untreated. This serious complication requires prompt diagnosis and treatment. Therefore, individuals with congenital red birthmarks should see an ophthalmologist for glaucoma screening, as delayed medical attention could result in loss of vision in the affected eye.
The main issue for those with dark birthmarks is cosmetic, though there is a smaller chance of glaucoma compared to red birthmarks. Nonetheless, annual eye exams are recommended.
Currently, red birthmarks are treated with vascular lasers to fade the marks, but complete removal is unlikely because the dilated vessels may lie too deep for the laser to reach fully. Early treatment increases the chances of complete or near-complete resolution.
Dark birthmarks are treated using pigment lasers, of which there are several types with very good results. Typically, 6 to 10 laser sessions are needed to fade the marks by about 70–90%, with some patients experiencing near-total clearance. On average, patients undergo about 10 sessions spaced every two weeks to two months.
Laser treatment is the primary method for both red and dark birthmarks, with minimal side effects and affordable costs—around a thousand baht per session. It offers effective results without hospital stays, allowing patients to return home immediately. Those concerned about red or dark birthmarks should consult a dermatologist for proper diagnosis and treatment.
Information provided by Associate Professor Dr. Somsak Tanrattanakorn, Department of Dermatology, Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University.