Beauty's not skin deep

Our baby Emma's birthmark is alarming, but harmless. Should we treat it, wonders Mark Piggott, or let it be?

The last days of Emma's first summer were drawing to a close. Waiting for a bus in Barnet, proud of myself for negotiating another day in charge of our seven-month-old daughter, a woman pointed into the pram, a mixture of horror and concern on her face. "Oh, no! What happened? The poor child! Did you do that?"

The last days of Emma's first summer were drawing to a close. Waiting for a bus in Barnet, proud of myself for negotiating another day in charge of our seven-month-old daughter, a woman pointed into the pram, a mixture of horror and concern on her face. "Oh, no! What happened? The poor child! Did you do that?"

It wasn't the first time a complete stranger had felt it necessary to point to Emma's prominent strawberry birthmark; it was her explicitly accusatory tone I didn't much care for. I regarded the woman slowly, trying to read her facial expression. "What do you mean?" I asked calmly. "Are you saying - I hurt her?" By now the tension in the bus queue was palpable and people were starting to look the other way. The woman smiled. "Oh no! Okay, it was not you who did this. It must have been God."

In her defence, the woman was probably making polite conversation, and her lack of English had chopped away the nuances - it does seem that foreigners are much keener to make some form of comment about Emma's mark than the more reserved English.

But when you're so proud of your child, wanting to show her off to everyone you meet, such reactions can be difficult to take; as can the polite silences and furtive glances from some members of your own family. Sometimes you can almost hear people thinking: what a shame. As if perhaps we should be ashamed - rather than proud of our beautiful firstborn.

Emma was born on 13 February this year - Friday the 13th. She had a couple of stork marks - also known as salmon patches - on the back of her scalp. These are common and, though they don't usually fade, are soon covered by growing hair. Emma's face was clear and beautiful, her eyes a deeper shade of the Celtic blue her mother and I had both inherited.

After a fortnight, a small pink mark began to appear between Emma's right eye and the inside of her nose: something like an anchor, or a Tracey Emin painting of a lorry. At first we suspected it was a scratch from her fingernails, or a sore spot from rubbing her sleepy eyes. As the mark grew, and assumed an angry red tone, we became somewhat paranoid. Was there any way we could have allowed milk-bottle sterilising fluid to drop on her skin? Had we scarred her in some furnace-related accident that had subsequently slipped our minds?

By the time she was six months old, Emma's mark had stopped growing outward but was still rising. It became apparent that the mark wasn't going to go away. Some cursory internet research and a chat with our GP informed us that Emma has haemangioma - an abnormally dense collection of small dilated blood cells. In other words - a tumour.

Just seeing the word "tumour" briefly filled us with terror; but haemangiomas of this type are benign. There are two distinct types - cavernous and capillary - of which the cavernous type is much more serious. Emma's type (also known as a strawberry nevus) is capillary.

It's estimated that up to one in 20 children develops some form of haemangioma, and of these around 80 per cent are on the head or neck. The condition usually disappears within a few years, but some remain and continue to develop. Emma's mark is still less than an inch across, but the dots have now joined and are still raised.

Although it's not usually dangerous, a number of problems are associated with the condition. These include ulceration, leading to weeping or bleeding. If too close to the eye, the child's vision can also be adversely affected. A much smaller percentage of sufferers develop other problems, including blood clotting difficulties.

Although not overly concerned, our GP advised us to take photographs each month, with a ruler next to Emma's mark. If it continues to grow, or leads to additional problems, there are a variety of options available. Jane Linward is a nurse who has worked at Great Ormond Street for 25 years, 10 of these within the birthmark unit, which treats 80 children each week; she was recently named as the King's Fund's Nurse of the Year.

"Unless the haemangioma keeps growing, the best advice would be to do nothing," says Jane. "Most haemangiomas will fade between the ages of five and seven, and all the available treatments carry some risks. Laser treatment is usually the best option, but under the age of one it is not advisable. General anaesthetic carries risks, and if awake, there's the risk of the child wriggling. And in any case, it would only remove the coloration, not the lump."

Nor would Jane advise someone in our position to remove the mark with general surgery. "Again there's the risk of the anaesthetic, and with all surgery you are left with a permanent scar which will be half as large again as the original mark - and would last for life."

Various drug treatments are available, but Jane is keen to emphasise the risks that can be associated with these. "Steroids can be injected into the mark over a long period, but this carries the risk of infection and other side-effects. Oral drugs (such as corticosteroids) can have side-effects including poor growth and high blood pressure. The immune system can also be adversely affected."

Doing nothing is our preferred option; wait until the mark fades of its own accord. There's just one problem with this plan of inaction: school. Children can certainly be cruel (I was), and the thought of Emma being teased is horrendous. Psycho-social impact can be just as damaging as other effects. Our society can be utterly unforgiving towards anything it perceives as different. Notions of perfection are unyielding: hence words such as blemish, flaw, imperfection. That's why we've decided to stop worrying and accept Emma's mark.

"There have actually been studies done which indicate children with facial marks have higher levels of awareness than other children," says Jane Linward. "They are more accustomed to people staring at them, and take much more notice of people's expressions. So in that sense, it can actually have beneficial qualities."

Every few months, we take Emma to a well-known chain of photography studios to get some portraits done. The images are stunning: Emma's eyes seem to become clearer and more beautiful at every sitting, her features more distinct. Ironically, it is the beauty of her eyes which often draws people to her distinguishing mark.

Emma's haemangioma is unavoidable. But the idea of airbrushing her mark out of existence isn't something we would even contemplate. It's just another of all those things which makes her unique; another part of her, which we love.

The Birthmark Support Group offers excellent advice for parents and sufferers. They are in the process of establishing a support group for adults. Details can be obtained from Louise Busfield at: PO Box 5109, Poole, Dorset BH14 9WG ( www.birthmarksupportgroup.org.uk; e-mail: funding@birthmarksupportgroup.org.uk)