Café-au-Lait Spots: Growth and Concerns in Adolescents

Café au lait spots

Dr.
Huang: Hello! I would like to ask if café-au-lait spots can increase in size with age.
My child had a café-au-lait spot measuring 2.5 cm x 2.8 cm on the lower back at birth, and now at 15 years old, it has grown to 3.0 cm x 3.5 cm.
Additionally, there are two small brown moles that appear normal on this spot, and there are about 20 to 30 smaller café-au-lait spots nearby, ranging from 0.1 to 0.5 cm.
Should I be concerned about this? Thank you so much! A worried mother.

Mrs. Hsu, 40~49 year old female. Ask Date: 2005/04/06

Dr. Huang Ruiyun reply Dermatology

The proportion will enlarge as the body grows.
If there are no café-au-lait spots larger than 1.5 cm, no brown spots in the armpits, normal development, and no numerous soft lumps under the skin, then there's no need to worry for now!

Reply Date: 2005/04/06

More Info

Café-au-lait spots, or 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. The presence of these spots is common and usually benign; however, their characteristics can sometimes raise concerns, especially when they change in size or number during adolescence.

In your case, the café-au-lait spot on your child's lower back has increased in size from 2.5 cm x 2.8 cm at birth to 3.0 cm x 3.5 cm at the age of 15. It is not uncommon for café-au-lait spots to grow slightly as a child matures, but significant changes in size or the emergence of new spots can warrant further evaluation. The presence of multiple smaller café-au-lait spots (0.1 cm to 0.5 cm) in the vicinity can also be a point of consideration.

From a medical perspective, while isolated café-au-lait spots are generally harmless, having six or more spots larger than 0.5 cm in diameter can be associated with certain genetic conditions, such as Neurofibromatosis type 1 (NF1). NF1 is characterized by the presence of café-au-lait spots, neurofibromas (benign tumors on nerves), and other skin manifestations. If your child has multiple spots and especially if they are increasing in number or size, it would be prudent to consult a dermatologist or a pediatrician who can perform a thorough examination and possibly recommend genetic counseling or further testing.

In terms of growth and development during adolescence, it is important to note that hormonal changes can affect skin pigmentation and the appearance of birthmarks. As your child goes through puberty, the body undergoes various changes, including shifts in hormone levels that can influence skin characteristics. However, any significant changes in existing spots or the appearance of new ones should be monitored closely.

If you are concerned about the café-au-lait spots or any associated symptoms, such as changes in skin texture, the development of new lesions, or any other unusual signs, it is advisable to seek medical advice. A healthcare professional can provide reassurance, conduct necessary examinations, and determine if any further action is needed.

In summary, while café-au-lait spots are usually benign, the increase in size and the presence of multiple spots in your child's case should be evaluated by a healthcare provider. Regular monitoring and open communication with a medical professional can help ensure that any potential issues are addressed promptly, allowing for peace of mind as your child continues to grow and develop.

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