Cafe Au Lait Spots Treatment & Management

Updated: May 19, 2020
  • Author: Nazanin Saedi, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Café au lait macules (CALMs) do not require medical care. When café au lait spots are associated with neurofibromatosis (NF) or another underlying condition, monitoring of associated conditions is required.

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Surgical Care

Although treatment of these lesions is not necessary, several lasers have been used to treat café au lait macules with variable responses. The lasers that have been used to treat café au lait macules include PDL, Er:YAG, Q-switched, and picosecond lasers. [10, 11, 12]

The risks of the procedures must be discussed with the patient and the family. The risks of laser surgery include transient hyperpigmentation, hypopigmentation, slight scarring, permanent hyperpigmentation, and recurrence. [13]

The data for the use of repeated Q-switched laser treatments are not consistent, with approximately 50% experiencing total clearance and with the other half developing recurrence and patchy pigmentation. [14] The reported responses to frequency-doubled Nd:YAG vary. [15, 16] One patient was treated with the Er:YAG and achieved almost complete clearance of the café au lait macules. [17] In one study, complete clearance of 34 café au lait macules was reported using a pulsed dye laser for 4-14 treatments, with no recurrences at 12 months follow-up. [18]

In 2012, Wang et al treated 48 Chinese patients with the Q-switched alexandrite laser and found that 26 patients (51.4%) had good-to-excellent responses after an average of 3.2 treatments with a low rate of recurrence (10.4%). The results are usually favorable, and when substantial clearing is achieved, the recurrence rate is low; however, where clearance is partial, recurrence is as high as 50%. The risk of postinflammatory hyperpigmentation is as high as 50% per treatment. When this develops, it is essential to wait until it clears before resuming laser treatment. [19]

In 2017, Belkin et al reported a retrospective study of 45 patients treated with the picosecond 755-nm alexandrite picosecond laser, Q-switched ruby laser, Q-switched alexandrite laser, or Q-switched 1064-nm Nd:YAG laser for irregularly bordered café au lait macules of the “coast of Maine” subtype and smooth-bordered “coast of California” subtype. [12] The irregularly bordered lesions received a mean visual analog score (VAS) of 3.67, corresponding to an excellent response on average (76-100% clearance) (P  <  .001).The smooth-bordered lesions, however, received a mean VAS of 1.76, corresponding to a fair response on average (26-50% pigmentary clearance). Based on their study, café au lait macules with jagged or ill-defined boarders of the coast of Maine subtype tend to respond better to laser treatment.

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Prevention

Guidelines for genetic counseling in patients with neurofibromatosis type 1 (NF1) have been established. [20]

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