Salmon Patch- Dermatology

Other names for salmon patches include:

• Nevus simplex
• Stroke bites (when on the neck)
• Angel’s kiss (when around the eyelids)
• Naevus flammeus simplex

Epidemiology

Salmon patches, or stroke bites, are the most common vascular malformation in infants, seen in up to 40% of newborn children of all races. Doctors believe that the condition is less frequent in darker-skinned babies. Both baby boys and baby girls are equally likely to have salmon patches.

Symptoms and features

Salmon patches, as the name implies, appear as flat skin patches that are pink to red in color. This patches can be single or multiple, and may be seen anywhere on your baby’s body, however, it’s most commonly observed in one of the following locations:

• Back of the neck
• Forehead
• Eyelids
• Between the eyebrows

The patches usually blanch (become white) when pressed, and have heterogeneous irregular borders. They can become darker and redder if your baby is emotional, crying, active, or straining. This should not be a concern, and it just implies that the blood is flowing more actively in the region.

Pathophysiology

Nevus simplex happens when blood capillaries in a certain region of the skin become abnormally dilated. This dermal capillary dilation causes the characteristic pink-red rash. The problem is thought to arise in the womb when the baby’s skin is forming, when an abnormal maturation of the skin cells in the affected region occurs.

 Diagnosis

A pediatrician can usually diagnose nevus simplex based on physical appearance and features without needing any further testing.

Differential diagnosis

Several other skin conditions can mimic nevus simplex and appear very similar. However, specific features can help pediatricians tell different conditions apart.

• Nevus flammeus: Also called “port-wine stain”, is another infantile skin condition caused by a vascular malformation. It is much less common than nevus simplex (affects around 0.3% of newborns only). The lesion is red in color and can appear in different parts of the body. The difference between nevus simplex and nevus flammeus is that the latter tends to affect a single side of the body (right or left), and becomes thicker and darker as the baby grows.
• Infantile proliferative haemangioma: These vascular tumors are seen in around 10% of babies by the time they reach 1 year. It’s more commonly found in girls but can affect boys as well. This lesion usually starts as a pinkish-red patch, but then it starts growing outwards and becomes raised above the skin. Similar to nevus simplex, haemangiomas also regress as the baby grows in most cases, however, they may leave a mark.

Associated conditions

Several other medical conditions have been associated with salmon patches. Patches that appear on the lower back of the baby (called “butterfly-shaped marks” or “midline lumbosacral nevus simplex”) can, for example, indicate spinal cord abnormalities. Depending on several other findings, the pediatrician might ask for further testing or imaging to rule out any neural tube defects if your baby has these.

Other conditions that may be associated with nevus simplex include:

• Beckwith–Wiedemann syndrome
• Macrocephaly-capillary malformation syndrome
• Odontodysplasia
• Nova syndrome
• Roberts syndrome
• Rubinstein–Taybi syndrome

Treatment

Salmon patches are harmless and almost always disappear by the time your child becomes a toddler without causing any problems. In the rare case when the rash persists into childhood, there are some treatment options available. Even though the rash by itself is not harmful, some parents might have cosmetic concerns and look for treatment, especially if the rash is located on exposed skin areas like the forehead. Dermatologists can pulsed dye laser to shrink down the dilated vessels causing nevus simplex, and this usually makes them disappear.

Nevus simplex is a very common harmless rash in newborns that usually fades away as your child grows. Rarely the rash persists, and when it does, a dermatologist can usually remove it using laser therapy.

Sources:

• https://pubmed.ncbi.nlm.nih.gov/20728246/
• https://pubmed.ncbi.nlm.nih.gov/2798254/
• https://pubmed.ncbi.nlm.nih.gov/3562091/
• https://pubmed.ncbi.nlm.nih.gov/18236823/

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