The so-called birthmark is a common name for congenital pigmented diseases and vascular diseases. Refers to the proliferation of capillary tissue or gene mutation of basal pigment cells during fetal development. Traditional Chinese medicine believes that it is caused by congenital endowment deficiency and qi stagnation and blood stasis. This disease usually exists at birth and is characterized by mature endothelial capillaries and pigment cells in the skin. Therefore, in a strict sense, birthmarks belong to the category of hemangioma treatment.
(2) Classification:
The color of the disease ranges from reddish to light blue, brownish blue, brownish black! If there are only mature endothelial capillaries but no pigment cells in the skin, and the skin color is red, reddish and light blue, we call these birthmarks red birthmarks, such as spotted nevus of newborn, orange spots and port wine stains. This birthmark is essentially a congenital dermal capillary malformation, that is, the gene regulation of ectoderm is abnormal during embryonic development, resulting in excessive vascular network in the skin. It is very close to the epidermis, through which you can see clearly. Press it with your finger and it will fade. Because most patients occur on the face, neck or hands, they become "red face", "red neck" or "red face" with different areas and unsightly appearance. If there are not only mature endothelial capillaries in the skin, but also a large number of pigment cells in the capillary tissue, it is called pigmented birthmark, such as nevus OTA, coffee spot and Mongolian spot. And the skin color of such birthmarks is mostly cyan, brown and black! Most of them are located in the area where sensory nerves are distributed, such as the trigeminal nerve area of the face. To sum up, we divide birthmarks into two categories: red birthmarks and pigment birthmarks.
Among them, the common types of red birthmarks are newborn Dot mole, orange Dot mole and wine Dot mole (port wine nevus), while the common types of pigmented birthmarks are Ota nevus, Mongolian spot, congenital melanocyte nevus and coffee milk spot.
(3) Harmfulness:
Most birthmarks are harmless to human health, such as Mongolian spots; However, some birthmarks are often malignant, while others suggest the possibility of systemic diseases, such as a certain number or size of brown spots and milk spots, so it is necessary to doubt the existence of neurofibroma, while red birthmarks, such as port wine stains, are often diffuse and are called "Red Sea" clinically. So birthmark is not only a sign, but also a secret code, which implies our health.
Types of birthmarks
Ota nevus
Ota nevus, also known as brown-blue nevus of upper palate, is a blue-brown plaque lesion affecting sclera and facial skin, which is innervated by trigeminal nerve. The lesions of nevus OTA are mostly distributed in the first and second branches of trigeminal nerve, which is a common pigmented birthmark of oriental nationalities, showing as blue-brown patchy nevus around the eyes (although sometimes not all of them appear at birth). In China, patients with nevus OTA account for about 0.4% of dermatology clinics and 2.6% of plastic surgery clinics, and the ratio of male to female is 1:3. About half of the patients found the disease at birth, but some patients began to find it in childhood, and only a few patients gradually appeared in adolescence, showing plaques composed of brown, gray and blue spots. The boundary of the lesion is unclear, and the spots in the lesion can be monochrome or both, with different colors. Due to the different density and location of melanocytes in dermis, plaques can appear light brown to dark blue, and different parts of the same lesion can appear different colors. The pathological changes of some patients have a tendency of gradual aggravation. Plaque occurs in forehead, eyes, cheeks and zygomatic region, which is equivalent to the distribution area of trigeminal nerve I and II, and can occupy all or part of this area. Plaque can occur on one side of the face, occasionally on both sides of the face, often symmetrical on both sides, and some melanocytes are also distributed in conjunctiva, cornea and retina. Ota nevus can grow slowly in the early stage, but the self-limitation of growth is difficult to determine. Some patients begin to be stable for a long time in childhood, and most experts think that they will be stable after puberty, but some people still have a slow growth trend until they are about 30 years old. Ota nevus has no genetic tendency and has no clear relationship with malignant transformation. Most nevus of OTA were born or shortly after birth, but some patients did not appear nevus of OTA until several years or even ten years after birth, and a few patients developed nevus of OTA later. But no matter when it grows, its properties are the same, and there is no difference. For patients with OTA nevus at birth or shortly after birth, OTA nevus usually fluctuates once in childhood and adolescence, that is, during this period, OTA nevus will grow up, or its color will become darker and more stable in the future. For patients with nevus of OTA in the future, nevus of OTA usually grows in childhood and adolescence. Of course, some patients grow nevus of OTA later. The color of Ota nevus can be determined.
Changes, such as darker colors in summer and lighter colors in winter, also affect colors through emotions. The clinical manifestations of nevus OTA vary greatly, from light brown spots or patches around the orbit to dark brown to blue-brown or blue-black spots on one or both sides of the face.
Elkfield point
Coffee spots are pigmented spots with regular edges, which sometimes coexist with multiple neurofibromas. Coffee spot is a hereditary skin disease. Melanin in melanocytes and keratinocytes in this disease is increased, and melanocytes are overactive, producing a large amount of melanin and forming pigmented spots. Coffee spots are light brown to dark brown spots or patches, which are similar to the mixed color of coffee and milk, so they are also called milk coffee spots, ranging from freckles to 20cm or larger, round, oval or irregular, with clear boundaries and smooth surface. It can appear at birth or gradually after birth and increase throughout childhood. It can occur in any part of the body and will not fade away by itself. It is reported that 10%-20% of children have a single coffee spot. More than 90% patients with neurofibroma have coffee spots, so some people think that the existence of neurofibroma should be highly suspected when there are more than six coffee spots with a diameter of 1.5 cm. Coffee spots can be diagnosed according to the characteristics of the birth of milk coffee spots with clear edges. It must be differentiated from freckles and simple freckles: freckles are small and have no large patch damage, mainly on the face. Simple freckles and nevus are mostly unilateral local diseases. Pathology also helps to differentiate.
Sanmol
Melanoma is the most common skin benign tumor, which is composed of normal pigmented nevus cells and occasionally appears on the mucosal surface. There are many types of clinical manifestations. The color is mostly dark brown or dark black, with colorless and colorless moles. Such as intradermal nevus, crossed nevus and mixed mole, as well as giant nevus, blue nevus and juvenile melanoma. Intradermal nevus is differentiated from large nevus cells, which are more mature small nevus cells and enter the dermis and its surrounding connective tissues.
Cross-border nevus, nevus cells are nested at the junction of epidermis and dermis, with clear boundaries and uniform distribution distance; The upper part of each nest is at the bottom of epidermis, and the lower part is at the superficial layer of dermis. These nevus cells are large nevus cells with deep pigment.
In the process of nevus cells entering the dermis, compound nevus often has intradermal nevus and residual borderline nevus at the same time, which is a mixed form of the above-mentioned car nevus. Some types can undergo malignant transformation under certain conditions, which deserves attention. Pigmented nevus mostly occurs in the face, neck, back and other parts, and can be seen in any normal human body. It can exist at birth or appear gradually in the first few years after birth. Most of them grow slowly, or remain unchanged for many years, but spontaneous degradation rarely occurs. Surgical and non-surgical treatment can be used. Good curative effect. Pigmented nevus is a congenital benign tumor, which is composed of pigment cells, most of which are benign. In the late stage of malignant transformation, once pigmented nevus becomes malignant, its malignant degree is extremely high, its metastasis speed is also the fastest, and its treatment effect is not ideal. The disease can be seen in all parts of the skin, with the face, neck, chest and back being the most common parts. A few occur in mucous membranes, such as mouth, labia and eyelid conjunctiva. Some borderline nevus pigmented nevus and pigmented nevus with malignant symptoms were removed in time.
Four-hair nevus
Black spot nevus is a kind of pigmented nevus, which often attracts special attention because of its local blackening, rough skin and long hard and short hair. Be careful. This kind of mole is particularly unsightly, with local blackening and rough or even raised surface, which "matches" with hard short hair. We should be more careful about moles that grow on parts of the body that are vulnerable to friction or injury. If the nevus grows rapidly, the color becomes lighter or darker, the surface is broken and scabbed, and even long-term unhealed ulcers appear, the surrounding lymph nodes are swollen, or some satellite-like small nevus appear around the big nevus, all of which indicate that the nevus has a tendency to become malignant, so we should go to the hospital dermatology department for timely treatment. Experts remind: nevus nigromaculatus may become cancerous and should be removed as soon as possible! ! !
Five hemangioma
Hemangiomas can occur in any part of the body, but the most common part is the face and neck, accounting for about 60% of all hemangiomas, most of which occur in the skin, subcutaneous tissue and oral mucosa of the face and neck. There are relatively few hemangiomas in deep and jaw bones, but the treatment is more difficult! Hemangioma is a congenital benign tumor, and it is a developmental malformation of blood vessels, which is more common at birth or shortly after birth. It originated from the residual embryonic vascular cells! At present, there is no unified classification standard for hemangioma in the world. In some medical books, hemangioma is called vascular malformation or vascular disease with the same name. Hemangiomas are divided into capillary hemangioma, cavernous hemangioma and tendinous hemangioma in domestic medical circles, among which capillary hemangioma and cavernous hemangioma are more common. At present, hemangioma has been repositioned internationally. Traditional hemangioma can be divided into two categories: hemangioma and vascular malformation. Hemangiomas are usually found at birth and can shrink by themselves. Hemangiomas have a rapid growth period at 6 ~ 12 months after birth, and gradually shrink after a few years. About 50% hemangiomas basically disappeared within 5 years, and some of them can last until 10 years old. Vascular malformation can be roughly divided into arterial malformation, arteriovenous malformation, venous malformation and capillary malformation.
Cutaneous hemangioma is a benign tumor originating from skin and blood vessels. It usually occurs in the skin of head and neck, but it can also occur in mucosa, liver, brain and muscle. It is often found at birth or shortly after birth. It grows rapidly in infancy, then it can gradually stop growing, and sometimes it can fade by itself. The incidence of hemangioma is reported by different families, which is about 3 ‰ ~ 1%. This disease is one of the most common soft tissue tumors. According to the statistics of Shanghai Medical University Cancer Hospital, cutaneous hemangioma accounts for 28% of all soft tissue tumors and 32% of benign tumors. The ratio of male to female is 1.2: 1. Skin hemangioma is generally divided into four types: nevus flammeus, strawberry hemangioma, cavernous hemangioma and mixed hemangioma.
I. nevus flammeus
Port wine nevus is also called port wine nevus, port wine nevus or telangiectasia nevus. Commonly known as "red birthmark". The disease is congenital capillary malformation, and there is no obvious gender difference. Most of them occur in early childhood, and the incidence rate is 0.3% ~ 0.5%.
Clinical manifestations often appear at birth or shortly after birth. The initial damage is one or several reddish, dark red or purplish red spots of different sizes, partially or completely faded, irregular, with clear boundaries, smooth surface, generally not higher than the skin surface, and telangiectasia can be seen. Damage can occur in all parts of the body surface, but it is more common in the face, neck and scalp, mostly unilateral, occasionally bilateral, and sometimes involving mucous membranes. Generally, the color deepens with age, and it can also be higher than the skin surface or nodular lesions occur on it. Occurred in the pillow, forehead or bridge of the nose, etc. Sometimes you can disappear by yourself.
It may be accompanied by other vascular malformations, such as meningeal arachnoid hemangioma, conjunctival, iris or choroidal hemangioma, leading to glaucoma or retinal detachment. Hypertrophic nevus flammeus with hypertrophy of soft tissue and bone, common varicose veins and arteriovenous fistula. Painful purple-blue nodules or plaques may appear on the calves and feet, and may fester.
Second, strawberry hemangioma
Strawberry hemangioma (hemangioma), also called capillary hemangioma or simple hemangioma, is a benign tumor mainly composed of capillaries and venules. The ratio of male to female is 1:3.
The clinical manifestations are one or several bright red, soft and lobulated tumors, which can reach several centimeters in diameter, and the surface is granular, resembling strawberries, with clear boundaries and not easy to fade. It usually occurs in the face, neck and scalp, and usually occurs 3 ~ 5 weeks after birth. At first, it was little red dot, and then it grew rapidly. At the age of 1 ~ 2, it stopped growing and then gradually degenerated. 70% ~ 80% of children can completely disappear by themselves when they are 5 ~ 7 years old. If there are no signs of deterioration before the age of 7, it is unlikely to fade. There are cavernous hemangioma in many cases.
Thirdly, cavernous hemangioma.
Cavernous hemangioma is a vascular malformation located in deep dermis and subcutaneous tissue. Cavernous hemangioma usually presents as venous malformation with low blood flow, so it is named because most venous malformations are spongy.
Clinical manifestations can occur in all parts of the body, but they are more common in the head and face, and can involve oral or pharyngeal mucosa. Generally, the damage is large, spontaneous, round or irregular, higher than the skin surface, nodular or lobulated, with unclear boundary, soft and elastic, mostly lavender or purple-blue, which can shrink after extrusion and fill quickly after decompression. If the part is deep, the color of the leather surface is almost normal. A few lesions were accompanied by strawberry hemangioma. Generally, it appears at birth and has a trend of continuous increase, but it usually develops slowly, often increases in childhood or adolescence, and is not obvious in adulthood. Some cases can subside naturally. Cavernous hemangioma is in danger of serious blood loss if it is ruptured due to trauma and secondary infection. In addition to deep dermis and subcutaneous tissue, lesions can also occur in submucosa, muscles and even bones. If bones, striated muscles or intestines are involved, corresponding symptoms can be caused. Occurred in liver, kidney and other internal organs, generally without conscious symptoms, common in autopsy or surgery, but also can cause oppression symptoms.
This disease can be a part of the following two rare congenital diseases: ① Blue rubber nevus: autosomal dominant inheritance, hemangioma not only involves the skin, but also often involves the intestine to cause chronic bleeding and anemia, and other organs such as oral mucosa, liver, spleen and central nervous system can also be involved. ②Maffucci syndrome: it may be accompanied by three kinds of vascular malformations, namely cavernous hemangioma, venous dilatation and lymphatic dilatation; Hemangioma involves skin and subcutaneous tissue, accompanied by cartilage dysplasia and ossification, and bone brittleness leads to deformity. In addition, there are osteochondroma, chondrosarcoma and other abnormalities.
Cavernous hemangioma can also be accompanied by thrombocytopenia and purpura, mainly in infants and occasionally in adults. Platelets can be reduced to (10 ~15) ×109/l, but purpura is not caused by thrombocytopenia, but a wasting coagulation disease, which is caused by blood coagulation and fibrin formation in hemangioma, resulting in the decrease of platelets, fibrinogen, prothrombin and prothrombin. About 1/4 cases may have bleeding, dyspnea, secondary infection or malignant transformation.
Interstitial hemangioma is a special cavernous hemangioma, which shows arteriovenous fistula on the basis of stable vascular malformation. It is a congenital arteriovenous malformation with high blood flow (common cavernous hemangioma often shows a venous malformation with low flow velocity). 65,438 0.5% of hemangioma is tendinous hemangioma, which mainly occurs in scalp, face, neck and limbs. The tumor and its surrounding blood vessels with thick pulsation are beaded or twisted, and the skin surface temperature is higher than that of normal skin, which can cause continuous tremor, and local auscultation can hear continuous blowing murmur. Tumors generally expand with age, and sometimes they suddenly increase rapidly after a few years of stability. In addition to increasingly affecting appearance and function, they may even involve heart function and endanger life. In addition, hemangioma has no possibility of regression, the incidence rate of female is higher than that of male, and the pregnancy situation tends to accelerate.
Fourthly, mixed hemangioma.
There are two or more types of hemangioma, one of which is dominant.
The treatment of mixed hemangioma should focus on deep lesions, such as deep cavernous hemangioma, strawberry hemangioma in the case of nevus flammeus combined with strawberry hemangioma, and finally treat superficial nevus flammeus.
Six freckles
Freckles are dark brown spots scattered on the face and other places. Generally, there are more children and women than men aged 5- 10, which can also occur in adolescent girls. After adulthood (after the age of 20), most spots are still and stop developing.
Under ultraviolet irradiation, tyrosinase activity in the basal layer increases, forming melanin, which is both freckles and gene spots. It is an innate fixture in the fetal period. Hereditary freckles can be divided into obvious spots and invisible spots. The obvious spots began to form at the age of 6- 12 and reached the peak at the age of 18. Most invisible spots appear on the face after pregnancy, which is why some people divide freckles into congenital freckles and acquired freckles. In fact, the endocrine of pregnant women will change greatly after pregnancy, which will stimulate the hidden freckles to break out, not to say that their freckles are formed the day after tomorrow. As long as freckles are genetic. The inheritance of freckles is characterized by atavism, which is why some parents have no freckles and their children have freckles. Although one or both parents' freckles did not appear, one or both parents' freckles were passed on to their children. The color and quantity of freckles depend on heredity, light intensity, age, region, race, occupation and working environment, and even have a certain relationship with different moods and adequate sleep. However, these relationships are mainly related to the genes of freckles.
verrucoid nevus
Verrucous nevus, also known as epidermal nevus and linear epidermal nevus, usually occurs at birth or in childhood, but also occurs in 10~20 years old, and can occur in both men and women.
It usually shows pale yellow to brown-black verrucous lesions. Its size, shape and distribution are different, and most of them are papillary bulges, which are arranged in strips, lines or patches, and can occur all over the body, especially in male and female genitalia, anus and its surroundings. At this time, it is often easily misdiagnosed as condyloma acuminatum. Key points of identification: verrucous nevus often occurs unilaterally, arranged in a linear pattern, hard, with clean damaged surface and not easy to bleed. Except for some special parts, the same rash often appears in other parts. Long medical history, poor efficacy of topical drugs. The pathological changes are epidermal hyperplasia in different degrees, mainly hyperkeratosis, papilloma-like hyperplasia, spinous hypertrophy, increased melanin in the basal layer, and no vacuoles in condyloma acuminatum, so the pathological identification is easy. Verrucous nevus has no symptoms, but it is not beautiful. After being treated by the skin spot treatment system, it basically belongs to normal skin.
Eight ITO nevus
The prevalence rate of ITO nevus in Japan is 0.3% ~ 1.0%, 65% of patients are born, the rest are mostly between 10 ~ 20 years old, and occasionally occur in late stage or pregnancy. Women are more common. The lesions are pale cyan, grayish blue, brownish blue to bluish black or brownish yellow patches or spots. The color of the center of the plaque is dark, and the edge gradually brightens. Occasionally, some areas of pigment patches may bulge, or even appear small nodules the size of millet to mung bean. The spots are distributed in clusters with different densities, or the center is a patch and the edge is a spot. The color of skin lesions is aggravated by sun exposure, fatigue, menstrual period and pregnancy. Some adolescence will deepen and expand. The most common sites involved in this disease are periorbital region, temporal region, forehead, zygomatic region and alar, and can also involve conjunctiva, cornea, iris, fundus, optic nerve, retrobulbar fat and periosteum around orbit. Ito's nevus belongs to the category of Ota's nevus, but their clinical manifestations and pathological changes are completely the same, mainly distributed in the areas dominated by the posterior supraclavicular nerve and the lateral arm nerve, such as the shoulder, neck and supraclavicular area, and some cases may be accompanied by ipsilateral or bilateral Ota's nevus.
[Diagnosis and differential diagnosis] According to the color, distribution and eye involvement of pigment, a diagnosis can be made. It should be differentiated from Mongolian spot and blue mole. Mongolian spots are born and can fade naturally. And doe not affect eyes and mucous membrane. In the tissue image, the number of melanocytes in dermis is less and the location is deeper. Blue nevus is a blue-black papule or nodule, which usually occurs on the back of hand, instep, face and buttocks. Melanocytes in tissue images gather together.
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