Getting a flawless skin becomes a priority for both men and women, and they try every tip and trick under the sun to keep their skin free from any marks or scars. Unfortunately, in many cases, the situation is out of their hand as pigmentation develops on the skin inherently or as a birthmark since birth. One such skin pigmentation concern is Cafe Au Lait Spots. They can damage the beauty of the skin when present in prominent locations such as the face or neck. Their treatment using cosmetic advancements is possible and within reach.

What Are Café Au Lait Spots?

Café Au Lait spots are irregularly shaped marks on the skin that are light brown to dark brown in color depending on your original skin colour. The name ‘café au lait’ means ‘coffee with milk’ in French and is used to signify the color of these spots on the skin. They are flat birthmarks and their size can range from 1-2 millimeters to even 20 centimeters.
These marks are also called as Cafe Au Lait macules, giraffe spots or Coast of Maine spots. They can be present right from the birth or develop during childhood. In rare cases, café au lait spots develop during adulthood.

Also Read: What Is Skin Pigmentation?

• Cafe Au Lait Spots In Babies & Children
In newborn babies and children, café au lait spots are common. They can develop anywhere on the body but most commonly on the torso. When the number of macules go beyond 3-4, an expert diagnosis is recommended to further assess the condition as higher number of café au lait spots are linked to a genetic disorder neurofibromatosis NF1.
Café au lait spots in babies can change in colour and size over the years. They can even become faint and become less noticeable as the baby grows.

• Cafe Au Lait Spots In Adults
From childhood to adult stage, the café au lait often become too light to notice. Prominent marks can be removed using treatments that involve using laser therapy to lighten them. In rare cases that the macules increase in number (more than 5 café au lait spots), diagnosis of neurofibromatosis is recommended for adults.

Ash Leaf Spots Vs. Café Au Lait Spots

A genetic disorder called tuberous sclerosis is responsible for the formation of ash leaf spots on the skin. These spots are hypopigmented, which means that they are lighter than the surrounding skin. They are almost white in colour and are present from birth or can develop during infancy. Café au lait spots are hyperpigmented marks on the skin that are darker than the surrounding skin. They can be caused due to tuberous sclerosis as well, where in both ash leaf spots and café au lait spots are present on the skin at the same time.

Also Read: How To Remove Pigmentation From Face?

Symptoms Of Café Au Lait Spots

a) Coffee coloured spots (can be dark brown for darker skin tones)
b) No itching sensation or pain associated
c) Usually flat (very rare cases of raised café au lait spots)
d) Irregularly shaped but defined edges
e) Vary in size from 1-2mm to 20cm
f) Shape, colour, and size can change over time

What Causes Cafe Au Lait Spots?

The mechanism that causes café au lait is the same as any hyperpigmentation that develops on the skin. Production of excess melanin in the affected area results in the formation of macules that are light brown to dark brown in colour. Small café au lait spots are common and can grow in size to become larger and cover a bigger area of the skin. In many cases, the spots are idiopathic in nature which means that the cause is unknown. This is usually seen as birthmarks where the café au lait spots in children are present from birth. Other causes of café au lait macules are associated to genetic conditions and syndromes. The most common ones are listed below –
• Neurofibromatosis NF1 (six or more spots that are bigger than 5mm before puberty or bigger than 15mm after puberty)
• Neurofibromatosis NF2
• McCune Albright syndrome
• Legius syndrome
• LEOPARD syndrome
• Bloom syndrome
• Fanconi anaemia
• Watson syndrome
• Congenital nevus
• Gaucher disease
• Hunter syndrome

Differential Diagnosis Of Café Au Lait Spots

The typical diagnosis of café au lait spots is by physical examination of the macules by a physician or a dermatologist. When just three café au lait spots are present or any other number under six, the chances of it being associated to NF1 are minimal. Such café au lait spots are not NF1 related and can be treated cosmetically. When there are six or more spots present, especially in areas not exposed to sunlight (armpits or groin), the chances of NF1 need to be tested and verified using differential diagnosis.
Genetic testing is the primary method of differential diagnosis for many syndromes associated with café au lait macules, including neurofibromatosis NF1. Multiple café au lait spots during childhood, puberty or adulthood are often signs of a genetic disorder being present and causing them.

Also Read: Skin Pigmentation Treatment

Treatment For Café Au Lait Spots

When exposed areas of the body develop these macules, such as café au lait spots on face, it can create embarrassment and social anxiety. Cosmetic methods can be used to lighten the spots and restore the skin’s beauty.
(i) Laser Treatment For Café Au Lait Spots – The use of laser to treat and get rid of hyperpigmentation of multiple kinds has been around for a while now. Cosmetic dermatologists utilize the latest laser equipment to treat café au lait spots too. The energy from the laser beam is directed on the affected skin specifically. This light energy destroys the accumulated melanin in the skin and causes effective lightening of large café au lait spots as well as small ones. A great advantage of laser treatment for cafe au lait spots are the lowered chances of any side effects developing. Mild redness and swelling are common, however these symptoms are transient and go away by themselves in a few hours.
Successive sessions of the treatment lighten the macules further until the desired results are achieved. Q-switched Nd:YAG laser is the most commonly used technology that is USFDA approved and has shown to provide noticeable results when performed by experienced dermatologists efficiently.
Additionally, other laser devices with varying wavelength’s are also used like Erbium: YAG laser, pulsed dye laser, etc. these have also shown effective fading of these spots over a period of few sessions, conducted at a fixed interval.
(ii) Other Treatments – If differential diagnosis confirms NF1 café au lait spots, then the doctor may prescribe medications, speech therapy, etc. to tackle the symptoms that this genetic disease can cause. There is no guaranteed treatment available for neurofibromatosis NF1. Cosmetic surgeries can also be performed that are invasive. But it can be decided by an expert dermatologist only.

FAQs

1. Do Café Au Lait Spots Fade?
Over the years, café au lait spots can become lighter than they were before. However, they do not fade away completely.

2. Can Café Au Lait Spots Be Normal?
Yes, café au lait spots can be normal as many people possess one to three such spots during their childhood. When the number of spots goes beyond five, it is best to get yourself diagnosed for NF1 and other syndromes that are associated with these spots.

3. How Many Café Au Lait Spots Are Normal?
Café au lait spots can differ widely in number, but any number below six is accepted as normal and not being related to neurofibromatosis NF1.

4. How Common Are Café Au Lait Spots?
Café au lait spots are very common and are seen as birthmarks in a wide range of population.

5. Are Café Au Lait Spots Dangerous?
In general, café au lait spots are not dangerous at all and are just benign birthmarks on the skin. Only when the number increases beyond five (six or more), the chances of neurofibromatosis NF1 and other syndromes such as McCune Albright syndrome becomes likely.

6. Café Au Lait Spots And Autism
Neurofibromatosis NF1 can cause nervous disorders such as autism, with more than 25% of children with the genetic syndrome developing autism spectrum condition. Since café au lait are linked to NF1, early differential diagnosis of these spots can help predict the incidence of autism in children.

7. Can Cafe Au Lait Spots Appear Later In Life?
Even though this is uncommon, café au lait can develop later in life as well. It is important to keep a tab on the number of spots that develop so that appropriate diagnosis and treatment steps can be undertaken.

8. Cafe Au Lait Spots Without Neurofibromatosis
Café au lait spots don’t always mean neurofibromatosis. There are chances that even though the number of spots matches the criteria for neurofibromatosis, there are other symptoms that need to be present too, to confirm the genetic disorder. Consulting an expert dermatologist is recommended if you suspect NF1.

Cafe au lait spots are a hyper pigmentation skin condition that should not be ignored, be it in children or in adults. Regular checkups will help you to commence appropriate treatment as and when necessary. If your spots are not associated to any syndrome or disease, speak to a cosmetic dermatologist at a reputed skin clinic to know if you are an ideal candidate to opt for laser treatment for cafe au lait spots.

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