Cafe Au Lait Macules Birthmarks
- Best Results2-3 treatments
- Treatment Recovery5-8 days
- Procedure Time5 to 15 minutes
- Skin SpecialistDavin Lim
- Duration of ResultsVariable
- Back to Work1-6 days
- Cost$-$$ (Medicare)
Cafe Au Lait Macules Birthmarks
Cafe Au Lait Macules are common birthmarks. They respond well to both nano & the latest pico lasers. Most patients require 2-4 sessions, depending on surface area, location, & skin type. Medicare provides some subsidy for this type of birthmark. Not all brown birthmarks are Cafe Au Lait Macules.
FactsFacts on CALM or Cafe Au Lait Macules
What are Cafe Au Lait Macules Birthmarks?
CALM or cafe au lait macules are common birthmarks occurring at birth. Some may be delayed (tardive birthmarks). These lesions may darken with sun exposure. The colour is uniformly brown, which contrasts with speckled naevi. The latter contains tiny dots of junctional & compound moles.
Most CALM birthmarks are not associated with any system abnormalities. A minority may be associated with NF1, NF2, & Mc Cune Albright syndrome.
How do I manage CALM birthmarks?
Most patients with Cafe Au Lait marks do not require or seek treatment. The exception is when these birthmarks occur on the face or neck. I normally treat people when they are bothered by them, usually around the teenage years.
What types of lasers can be used to treat CALM & brown birthmarks?
My preferred lasers are nano or pico lasers. They include Picoway, Picosure (not enough energy), C6, Revlite, Pastelle & Spectra lasers. IPL or intense pulse light can treat CALM using the pigment wavelength. I don’t like using it because it has too much collateral damage. Additionally, IPL is not covered under Medicare.
Is laser treatment painful?
Yes, it hurts a lot. But there are ways to reduce the pain. I use a combination of cooling, numbing cream, injections & laughing gas. This make treatments easy & super-fast. It takes only a minute or two to treat the average CALM.
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What is the recovery following a laser?
About 5 to 8 days. Depends on the location and surface area. Birthmarks on the face heal up faster than those located on the trunk & limbs. Treated areas will bruise significantly for a few days before scabbing over. Pico lasers may give less inflammation & downtime compared to older nano lasers. You are required to keep the wound moist- grease for peace. If it scabs, it scars. In darker skin patients you may be red (or brown) for a few weeks after the laser. This is normal. Do not panic, keep out of the sun, it will resolve. PIH is more common the darker your genetic skin colour.
How many laser sessions will you need?
The number of sessions depends on 6 factors-
- The diagnosis. CALM lesions require less, Hori & Ota requires more.
- Your skin type. Darker you are, more sessions.
- The surface area. Big ass birthmarks require more sessions.
- The laser used. In some, but not all cases, pico lasers give faster results.
- The location. Face lesions do really well, legs & feet need more sessions.
- How cool you are. If you are anxious and worried about things, I may elect to use more conservative treatments.
Here is a summary; CALM lesions I can normally treat in 2-3 sessions. Ota, Ito, Hori, about 4-7 sessions over 6-18 months.
Can creams treat birthmarks?
No, creams are useful for other forms of pigmentation, but they have marginal benefits for brown birthmarks including Cafe Au Lait Macules.
What are speckled naevi?
This is when a CALM parties with a whole lot of moles to give birth to a birthmark with elements of CALM & junctional & compound nevi. Using logic, you would expect the more homogeneous CALM to respond nicely to lasers. It is not the case. Treatments are pretty unpredictable. PIH has frequently seen post-treatment. This type of birthmark has an increased risk of melanoma. You should be followed up by a medical dermatologist.
Will birthmarks recur?
Recurrence is possible, most patients get significant remission for 2-5 years. If it recurs, CALMs can be retreated. There is no increased incidence of skin cancer in these birthmarks, so don’t stress. The only way to ensure that birthmarks do not return is to cut them out. This is appropriate for smaller lesions like congenital nevi but is an overkill for cafe au lait macules.
As a guide the following birthmarks can respond to lasers:
- Cafe au lait macules
- Ota & Ito birthmarks
- Hori’s Nevus (latent dermal melanocytosis)
- Red birthmarks, PWS angiomas, etc.
What can you do to reduce recurrence?
Sun protect & use lots of sunscreens. CALM & brown birthmarks are made up of pigment cells called melanocytes. With adequate sun protection these cells are kept relatively quiet.
How to get started?
Book an appointment with myself. I really do need to see you in real time to ascertain a firm diagnosis. From there, I will formulate a plan. A referral is needed from your GP as I am a medical specialist. Laser treatment carries a Medicare rebate.
Davin’s Viewpoint; CALM birthmark treatment
CALM birthmarks are easy to treat. Even older nano lasers can give outstanding results. Speckled nevi are much harder to treat, whilst Becker nevus are almost impossible to treat. There are over 150 different types of birthmarks, a diagnosis is required as this confers prognosis following lasers.
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