Learn about Mongolian Spots: Causes, Pictures, Removal Options

What are Mongolian Spots?

Mongolian spots are flat, blue or blue-gray birthmarks that are present at birth. They are benign skin markings that are most commonly found on the lower back or buttocks of infants. Mongolian spots are sometimes colloquially referred to as "blueberry stains" or "sacral spots". The medical term for them is congenital dermal melanocytosis.

Mongolian spots are congenital birthmarks, meaning they are present at birth. They are caused by a concentration of melanocytes - the cells that produce melanin - deep within the skin. This increased pigmentation results in the slate blue coloring of the birthmark.

Mongolian spots are most prevalent among individuals of East Asian, Native American, Hispanic and East African descent. However, they can appear in babies of any race. Up to 90 percent of Asian and Native American infants have Mongolian spots at birth.

Common Locations

The most common location for Mongolian spots is the lower back or buttocks. However, they may also develop on other areas:

• Back
• Shoulders
• Legs
• Feet
• Arms
• Forehead
• Face

In most cases, Mongolian spots on the extremities are smaller and fainter in color than those on the back and buttocks.

Appearance

Mongolian spots typically have the following characteristics:

• Blue or blue-gray color
• Flat, not raised above the skin
• Irregular borders that "fade out"
• Range in size from a dime to about 8 inches wide
• Located deep in the skin, not superficial

The coloration can vary from a faint blue tinge to very dark blue or gray. Mongolian spots do not lose color when pressed on, which helps distinguish them from bruises.

Mongolian Spot Pictures

Here are some photos of Mongolian spots in infants and children:

This is a large Mongolian spot located on the lower back of an infant. The borders fade out gradually. The color is a dark slate blue.

This Mongolian spot on the buttock has jagged, irregular borders. The color is blue-gray and unevenly pigmented.

These are smaller Mongolian spots located on the shoulders and arm. As is typical, the ones on the extremities are smaller and paler in color.

This is an example of a Mongolian spot on the face, often referred to as nevus fuscocaeruleus or Mongolian nevus when located on the head or neck. These tend to be smaller and fainter.

Are Mongolian Spots Dangerous?

Mongolian spots are benign skin markings that do not pose any health risks. They are simply a variation in skin pigmentation. Mongolian spots are not associated with any medical disorders or complications.

Rarely, extensive or atypical Mongolian spots can indicate an underlying disorder such as:

• Hypomelanosis of Ito
• Incontinentia pigmenti
• Neurofibromatosis

However, in most infants Mongolian birthmarks are an isolated finding with no other health concerns.

Do They Go Away?

Mongolian spots typically start to fade some time during early childhood, between age 2 and 6. However, the exact timing of when they disappear is variable:

• Spots on the lower back and buttocks often last the longest, sometimes persisting up until puberty.
• Spots on the extremities tend to go away sooner, by age 4 or 5.
• Head and facial spots generally fade fastest, often gone by 12-18 months of age.

While Mongolian spots are present at birth, they can sometimes intensify and become darker or more noticeable over the first few months of life before eventually fading.

Causes

The exact cause of Mongolian spots is unknown, but they appear to be influenced by both genetic and environmental factors:

• Genetic - Mongolian spots occur more frequently in certain ethnic groups, indicating a possible genetic component.
• Melanocytes - The melanocytes producing melanin pigment are abnormally distributed in the skin.
• Hormones - Estrogen from the mother may affect melanocyte activity in utero.

The slate blue color comes from melanocytes localized deep in the dermis layer of skin. This contrasts with typical skin pigmentation where melanocytes are scattered evenly throughout the upper layers.

Who Gets Them?

Mongolian spots occur most commonly in Asian, Native American, Hispanic and East African infants. Rates range from over 90% of newborns in Asian populations down to around 10% of Caucasian babies.

Darker skin color appears to correlate with a higher incidence of Mongolian spots. However, fair-skinned babies can also develop these birthmarks.

Diagnosis

Mongolian spots are readily identified by their distinct appearance. No specific diagnostic testing is required in most cases. However, the doctor may carry out tests to rule out bruising or other discoloration.

Diagnosis is based on evaluation of the characteristics:

• Location on lower back/buttocks
• Blue or blue-gray color
• Irregular borders
• Does not blanch when pressed on
• Present at birth

Biopsy is not needed unless the spot has an atypical appearance. Testing for melanin content can confirm increased levels in the deep dermis.

Rarely, extensive Mongolian spots may warrant further evaluation and blood tests to check for associated conditions like neurofibromatosis or Hypomelanosis of Ito.

Differential Diagnosis

The doctor may consider other causes of skin discoloration in the differential diagnosis:

• Birthmarks - Cafe-au-lait spots, congenital nevi
• Bruises - Bleeding underneath the skin from injury or baby delivery
• Hemangiomas - Benign vascular lesions appearing as red or purple spots
• Melanocytic nevi - Moles

A thorough physical exam along with information about the time of onset will help distinguish Mongolian spots from bruises, cafe-au-lait macules and other types of birthmarks.

Treatment and Removal

No specific treatment is required for Mongolian spots, as they are harmless benign markings. The spots will fade gradually over time without intervention. Parents can be reassured that the marks do not indicate any medical problem.

Cosmetic removal may be sought in some cases. However, treatment is generally not recommended due to potential risks and complications:

• Laser therapy - Laser removal can potentially scar or permanently damage skin. Results are not guaranteed.
• Cryosurgery - Freezing with liquid nitrogen may lighten the spots. High risk of hypo or hyperpigmentation.
• Dermabrasion - Mechanically "sanding" skin changes appearance but does not remove melanocytes.

Many experts advise against treatment until the child is old enough to make the choice themselves. Spots in discreet locations often do not need intervention.

Home Remedies

Home treatment methods like scrubbing or using creams are not proven effective and may worsen the appearance. The only appropriate option is to leave the Mongolian spots alone and wait for them to naturally fade.

When to See a Doctor

Consult a pediatrician promptly for any new markings or discoloration on a baby. The doctor can determine if it is likely a benign Mongolian spot or requires further evaluation.

Contact a dermatologist if:

• The spot has an atypical appearance or location
• Multiple spots start appearing after several months of age
• The markings do not fade by school age years
• Your child experiences pain, itching or other symptoms

Parents should also let their child's doctor know if there is a family history of genetic disorders involving pigmented birthmarks.

Prevention

There is no known way to prevent Mongolian spots since the cause is uncertain. They occur by chance depending on genetic and possibly hormonal factors in utero. Prenatal care and good nutrition may help reduce the severity.

Living with Mongolian Spots

While parents may worry about the appearance of Mongolian spots, they can be reassured that the markings are harmless. However, there are a few things families can do to cope with these birthmarks:

• Educate family/friends - Explain to loved ones that the spots are common in some ethnicities and not bruises or signs of injury.
• Protect from injury - Use soft clothing and padding while the spots remain to avoid scraping or irritation.
• Sun protection - Apply broad spectrum sunscreen to help prevent tanning or darkening of the spots.
• Avoid treatments - Do not try to scrub, bleach or remove birthmarks at home as this can cause scarring.

With time, Mongolian spots tend to fade to the point of being almost unnoticeable. They do not interfere with baby's health or development.

Coping Strategies

If your child becomes self-conscious about their birthmark, there are some coping strategies that may help:

• Reassure them the marking does not mean anything is wrong with their skin and many children have the same spots.
• Have the child come up with a fun nickname for their birthmark if they want.
• Draw attention away by accessorizing with stickers, temporary tattoos or clothing prints near the area.
• Teach your child appropriate responses if questioned or teased by other kids.

Building confidence and self-esteem allows the child to focus on more positive attributes.

When to Worry

In most infants, Mongolian spots are benign findings that disappear in early childhood without issue. However, parents should contact the doctor promptly about any of the following:

• Change in appearance - The spot changes color, texture, size or shape. New spots develop.
• Associated symptoms - Spreading itchiness, pain, swelling or other skin changes near the spot.
• Growths or nodules - Hard lumps, bumps or lesions develop within the birthmark.
• Does not fade - Spot remains very dark and prominent years after infancy.

While most Mongolian spots are harmless, rarely they can be a sign of an underlying disorder. Parents should follow up with the pediatrician about any concerning or atypical features.

When to Seek Specialist Care

Consultation with a dermatologist or specialist may be recommended if:

• Your child has an unusually large, dark or widespread Mongolian nevus on the scalp, face, neck or torso.
• The markings are still prominent and have not faded much by age 5.
• Your child experiences pain, itching or bleeding from the spot.
• Signs of an associated condition like neurofibromatosis are present.

A specialist can evaluate your child's birthmark with special imaging techniques and determine if biopsy or testing is needed.

The Takeaway

Mongolian spots are common birthmarks, especially in babies of Asian, Hispanic, East African and Native American descent. These flat, blue or blue-gray markings most often appear on the lower back, buttocks, shoulders and torso.

While noticeable at birth, the spots are considered benign and tend to fade by early childhood. No treatment is required for typical Mongolian spots. Laser therapy risks permanent scarring and other complications.

Parents can be reassured that these skin markings do not indicate bruising, injury or any health problems. However, any sudden change in appearance or associated symptoms should be evaluated.

With education and support, Mongolian spots can be accepted as an innocuous variation rather than a worrisome condition needing correction.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.