What is Angel's Kiss in Infants?
An "angel's kiss" is a benign capillary malformation (also called nevus simplex or salmon patch) that appears as a flat, pink or red birthmark commonly located on the forehead, glabella, upper eyelids, upper lip, or nose in newborns. 1, 2
Clinical Characteristics
- Appearance: Flat, pink to salmon-colored vascular lesion with poorly defined borders 3, 4
- Common locations: Forehead, glabella (between eyebrows), upper eyelids, upper lip, and nose 1
- Present at birth: Unlike infantile hemangiomas which develop after birth, angel's kiss is visible from birth 4, 5
- Benign nature: Does not hurt and carries no serious medical significance 2
Natural History and Prognosis
- Spontaneous resolution: Approximately 50% of facial lesions (angel's kiss) fade and disappear during the first years of life 1
- Distinction from nuchal lesions: The nuchal/occipital variant (called "stork bite") tends to persist more commonly than facial lesions 1
Key Distinction from Other Vascular Lesions
The critical pitfall is confusing angel's kiss with infantile hemangiomas or true port wine stains, as these require entirely different management approaches. 4
- Angel's kiss (nevus simplex): Flat, present at birth, pink/salmon-colored, poorly defined borders, often fades spontaneously 3, 4, 5
- Infantile hemangioma: Raised, highly vascular, appears within first 4 weeks of life, proliferates rapidly between 5-7 weeks, requires treatment consideration 3, 4
- Port wine stain (nevus flammeus): Flat, present at birth, darker red-purple color, well-defined borders, does NOT fade spontaneously, may require laser treatment 3, 4, 5
Management Approach
Reassurance is the primary management for angel's kiss, as most facial lesions resolve spontaneously without intervention. 6, 5
- No imaging required: These benign capillary malformations do not require ultrasonography or other imaging studies 5
- No treatment necessary: Unlike port wine stains, angel's kiss lesions typically do not warrant laser therapy 5
- Parental counseling: Inform parents that approximately 50% will fade during early childhood 1
- Follow-up: Routine well-child visits are sufficient for monitoring 6
When to Reconsider the Diagnosis
If the lesion demonstrates any of the following features, reconsider whether this is truly a benign nevus simplex:
- Raised or thickened texture: Suggests infantile hemangioma rather than nevus simplex 3, 4
- Rapid growth after birth: Infantile hemangiomas proliferate between 1-3 months of age 3
- Dark red-purple color with sharp borders: Suggests port wine stain, which requires assessment for Sturge-Weber syndrome if involving V1 distribution 4, 5
- Located over the spine: Midline spinal lesions are intermediate-risk markers for spinal dysraphism and require imaging 3, 4