OVERVIEW

What is café-au-lait macules?

Café-au-lait macules, also known as coffee-with-milk spots, are named for their light brown appearance (resembling the color of mixed coffee and milk). They are a relatively common pigmented skin condition.

Café-au-lait macules appear as light to dark brown spots or patches with clearly defined borders. Their size can range from a few millimeters to several centimeters, and their shapes may vary, but the skin texture remains normal.

Café-au-lait macules are not malignant and generally do not require treatment. However, laser therapy may be considered for cosmetic concerns. Treatment effectiveness depends on factors such as age, location, color depth, and shape. Recurrence after laser treatment is possible, though the exact cause remains unclear.

Are café-au-lait macules common?

Approximately 10%–20% of the general population may develop café-au-lait macules at birth, during infancy, or in early childhood. These spots can enlarge as the body grows and do not fade on their own. About 1% of healthy young adults also have café-au-lait macules.

Are café-au-lait macules the same as birthmarks?

Simply put, birthmarks include café-au-lait macules, but café-au-lait macules are not necessarily birthmarks. In patients with neurofibromatosis, café-au-lait macules are a skin-level manifestation of the condition.

SYMPTOMS

What are the common manifestations of café-au-lait spots?

They appear as light to dark brown spots or patches with clear boundaries, varying in size and shape, but the skin texture remains normal.

Where do café-au-lait spots commonly occur?

Café-au-lait spots can appear anywhere on the body, though they rarely occur on the palms or soles. They most commonly appear on the face and torso.

How do café-au-lait spots develop?

Café-au-lait spots primarily result from an increase in melanocytes, heightened activity, and excessive melanin production, leading to pigmented patches.

What serious consequences can café-au-lait spots cause?

Café-au-lait spots are benign and do not cause any harm. In most cases, they do not require treatment.

CAUSES

What are the causes of café-au-lait spots?

The causes of café-au-lait spots vary, but the exact pathogenesis remains unclear. The following factors may contribute but cannot be confirmed:

• Neurofibromatosis—90% of neurofibromatosis patients have café-au-lait spots.

• Genetic factors—familial tendencies for café-au-lait spots exist even in patients without neurofibromatosis, though this is not always the case.

• A marker of systemic diseases, such as tuberous sclerosis or ataxia-telangiectasia.

• They can also occur in healthy individuals and are unrelated to sun protection.

What is the relationship between café-au-lait spots and neurofibromatosis?

90% of neurofibromatosis patients have café-au-lait spots. If more than six spots larger than 5mm in diameter appear before puberty, or more than six spots larger than 15mm appear after puberty, neurofibromatosis may be suspected.

Neurofibromas do not develop from café-au-lait spots; rather, the spots are a cutaneous manifestation of neurofibromatosis.

Neurofibromatosis may affect bone growth, nervous system development, and even intelligence, though not everyone experiences these complications. In rare cases, malignant transformation may occur.

Close monitoring is necessary to detect systemic tumors or developmental abnormalities in children, with prompt medical attention if issues arise.

Are café-au-lait spots hereditary?

There is a genetic component, but they are not guaranteed to be passed to the next generation.

DIAGNOSIS

How is café-au-lait spot generally diagnosed?

When diagnosing café-au-lait spots, doctors primarily refer to the shape and appearance of the spots or patches. However, the size and number of pigmented spots are significant for diagnosing related conditions such as neurofibromatosis.

TREATMENT

Which department should I visit for café-au-lait spots?

Dermatology.

Can café-au-lait spots disappear on their own?

Café-au-lait spots generally do not fade away by themselves.

How are café-au-lait spots treated?

Café-au-lait spots are not malignant and usually do not require treatment. However, if appearance is a concern, treatment options are available. The primary method is laser therapy, which typically requires multiple sessions. Some patients may experience recurrence, though the cause remains unclear, making prevention difficult.

Can cosmetic spot-removal products eliminate café-au-lait spots?

No. Since the melanocytes in café-au-lait spots are located within the epidermis, topical cosmetic products applied externally cannot effectively remove them. Laser treatment is the only viable option.

What are the common risks of laser treatment for café-au-lait spots?

• Laser treatment works by targeting melanin in the skin with light beams to break it down and remove spots. However, if the beam energy is too high, it may cause temporary redness and swelling, which usually subsides quickly. A 20–30-minute cold compress can help alleviate redness and heat if needed.

• In rare cases, improper technique or incorrect treatment depth may damage skin tissue, leading to noticeable scarring.

How long is the recovery period after laser treatment for café-au-lait spots?

After laser treatment, the scab at the treated area will naturally fall off in about 7–10 days. Avoid peeling it off manually, as this may worsen pigmentation or cause scarring.

Can café-au-lait spots be completely cured?

Some patients see significant improvement after treatment, but recurrence is possible after six months, a year, or even longer. If spots reappear, patients should schedule follow-up visits for early medical intervention based on a doctor's evaluation.

DIET & LIFESTYLE

What should patients with café-au-lait spots pay attention to in their diet?

Maintain a normal diet, as café-au-lait spots themselves do not cause any harm to the body.

What precautions should be taken after laser treatment for café-au-lait spots? How to care for the skin post-treatment?

• Keep the treated area clean to avoid infection and friction.

• The scab usually falls off naturally in 7–10 days. Do not peel it off manually, as this may worsen pigmentation and increase the risk of scarring.

• Mild burning sensations or slight redness in the treated area are normal. If necessary, apply a cold compress for 20–30 minutes to alleviate redness or heat.

Are café-au-lait spots related to drinking coffee?

No, they are unrelated.

Is follow-up required after café-au-lait spot treatment?

Generally, no follow-up is needed. However, if recurrence occurs, a hospital visit may be necessary to assess whether retreatment is required.

PREVENTION

Can coffee-colored spots be prevented?

The cause of coffee-colored spots is still unclear, and it is unrelated to sun exposure, so there is currently no effective way to prevent them.