Café-au-Lait Spots: Causes, Concerns, and Treatment Options

Many small café au lait spots?

Hello Doctor: I have many small café-au-lait spots around my left eye and forehead (there are several dozen that look like sunspots, all less than 1 centimeter, about a few millimeters).
I only found out they were café-au-lait spots when I recently visited a dermatologist for laser treatment.
They probably started appearing around middle school when I had a lot of acne on my face and was often exposed to the sun; I wonder if that has any relation? I also have a few café-au-lait spots on my hands, abdomen, and thighs, and I remember having a small bump on the inner side of my right arm when I was a child, but I scratched it and it eventually broke.
I am wondering if that was a tumor.
1.
I would like to ask the doctor if this is neurofibromatosis? 2.
Will café-au-lait spots continue to increase in number? 3.
If I haven't developed any new spots after puberty, can I be reassured?

Guang, 20~29 year old female. Ask Date: 2019/08/09

Dr. Wu Yuxin reply Dermatology

1.
The lesion is not visible, and it is not possible to determine the issue.
If it is causing significant distress, please seek medical attention promptly.
2.
Both are hypothetical questions, and I cannot provide answers.

Reply Date: 2019/08/09

More Info

Café-au-lait spots, also known as café-au-lait macules, are flat, pigmented birthmarks that can vary in size and number. They are typically light brown in color and can appear anywhere on the body. Understanding the causes, concerns, and treatment options for these spots is essential, especially when they appear in clusters or are associated with other symptoms.

1. What Causes Café-au-Lait Spots?
Café-au-lait spots are caused by an increase in melanin, the pigment responsible for skin color. They can occur in anyone and are often benign. However, when multiple spots are present, they may be associated with genetic conditions such as Neurofibromatosis type 1 (NF1), which is characterized by the presence of six or more café-au-lait spots, neurofibromas (benign tumors on nerves), and other skin changes.

2. Are Café-au-Lait Spots a Concern?
While café-au-lait spots themselves are usually harmless, their presence can be a marker for underlying conditions. If you have multiple spots, especially if they are accompanied by other symptoms such as freckling in unusual areas, bone abnormalities, or neurofibromas, it is advisable to consult a healthcare professional for further evaluation. In your case, the presence of multiple spots on your face, arms, and abdomen, along with a history of a small bump on your arm, could warrant further investigation to rule out conditions like NF1.

3. Will Café-au-Lait Spots Increase in Number?
Café-au-lait spots can appear during childhood and adolescence, and their number may increase over time. However, it is not uncommon for new spots to develop during periods of growth, such as puberty. If you have noticed that the spots have been stable since your teenage years, it may indicate that they are not likely to increase significantly. Nonetheless, monitoring any changes in size, shape, or number is essential.

4. Can I Relax After Puberty?
While many individuals find that their café-au-lait spots stabilize after puberty, it is essential to continue monitoring your skin. If you notice any new spots or changes in existing ones, it is advisable to consult a dermatologist. Regular skin checks can help ensure that any potential issues are addressed early.

5. Treatment Options
If you are concerned about the appearance of café-au-lait spots, there are treatment options available. Laser therapy is one method that can help lighten or remove these spots, but it is essential to discuss the potential risks and benefits with a dermatologist. They can provide guidance on the most appropriate treatment based on your skin type and the characteristics of the spots.

Conclusion
In summary, café-au-lait spots are generally benign but can be associated with genetic conditions when present in significant numbers. It is crucial to monitor any changes and consult a healthcare professional if you have concerns. While treatment options are available, understanding the nature of these spots and their potential implications is vital for your peace of mind and overall skin health. If you have any further questions or concerns, do not hesitate to reach out to a dermatologist for personalized advice and care.

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