Café au lait spot

Café au lait spots, or café au lait macules, are flat, hyperpigmented birthmarks.^[1] The name café au lait is French for "coffee with milk" and refers to their light-brown color. They are caused by a collection of pigment-producing melanocytes in the epidermis of the skin.^[2] These spots are typically permanent and may grow or increase in number over time.^[3]

Café au lait spot
A café au lait spot on a patient's left cheek
Specialty	Dermatology

Café au lait spots are often harmless but may be associated with syndromes such as neurofibromatosis type 1 and McCune–Albright syndrome.^[3] Café au lait lesions with rough borders ("coast of Maine") may be seen in McCune–Albright syndrome.^[4][5] In contrast, café au lait lesions of neurofibromatosis type 1 have smooth borders ("coast of California").^[5]

Cause

Neurofibromatosis type I café au lait spot

Further information: List of conditions associated with café au lait macules

Café au lait spots can arise from diverse and unrelated causes:^[6][7]

• Ataxia–telangiectasia
• Basal cell nevus syndrome
• Benign congenital skin lesion
• Bloom syndrome
• Chédiak–Higashi syndrome
• Congenital melanocytic naevus
• Fanconi anemia
• Fibrous dysplasia of bone
• Gaucher disease
• Hunter syndrome
• Jaffe–Campanacci syndrome
• Legius syndrome
• Maffucci syndrome
• They can be caused by vitiligo in the rare McCune–Albright syndrome.^[8]
• Multiple mucosal neuroma syndrome
• Having six or more café au lait spots greater than 5 mm in diameter before puberty, or greater than 15 mm in diameter after puberty, is a diagnostic feature of neurofibromatosis type I (NF-1), but other features are required to diagnose NF-1.^[2] Familial multiple cafe-au-lait spots have been observed without an NF-1 diagnosis.^[9]
• Noonan syndrome
• Silver–Russell syndrome
• Tuberous sclerosis
• Watson syndrome
• Wiskott–Aldrich syndrome

Diagnosis

Diagnosis is visual with measurement of spot size. The number of spots can have clinical significance for diagnosis of associated disorders such as neurofibromatosis type I. Six or more spots of at least 5 mm in diameter in pre-pubertal children and at least 15 mm in post-pubertal individuals is one of the major diagnostic criteria for NF1.^[10]

Prognosis

Café au lait spots are usually present at birth, permanent, and may grow in size or increase in number over time.^[3]

Café au lait spots are themselves benign and do not cause any illness or problems. However, they may be associated with syndromes such as neurofibromatosis type 1 and McCune–Albright syndrome.^[3]

The size and shape of the spots can vary in terms of description. In neurofibromatosis type 1, the spots tend to be described as ovoid, with smooth borders. In other disorders, the spots can be less ovoid, with jagged borders. In neurofibromatosis type 1, the spots tend to resemble the "coast of California" rather than the "coast of Maine", meaning the edges are smoother and more linear.^[2]

Treatment

Café au lait spots can be removed with lasers.^[11] Results are variable as the spots are often not completely removed or can come back after treatment. Often, a test spot is treated first to help predict the likelihood of treatment success.^[12]

See also

• Birthmark
• Nevus
• List of cutaneous conditions
• List of conditions associated with café au lait macules

References

1. Plensdorf S, Martinez J (January 2009). "Common pigmentation disorders". American Family Physician. 79 (2): 109–16. PMID 19178061.
2. Listernick, Robert; Charrow, Joel (2012). "Chapter 141: The Neurofibromatoses". In Goldsmith, Lowell; Katz, Stephen I.; Gilchrest, Barbara A.; Paller, Amy S.; Leffell, David J.; Wolff, Klaus (eds.). Fitzpatrick's dermatology in general medicine (8th ed.). New York: McGraw-Hill Medical. ISBN 978-0-07-166904-7.
3. Morelli, JG (2013). CURRENT Diagnosis & Treatment: Pediatrics, 22e. New York, NY: McGraw-Hill. pp. Chapter 15: Skin. ISBN 978-0-07-182734-8.
4. "coast of Maine spots - General Practice Notebook". Archived from the original on 2017-12-01. Retrieved 2011-12-31.
5. Jameson, J. Larry; Kasper, Dennis L.; Longo, Dan L.; Fauci, Anthony S.; Hauser, Stephen L.; Loscalzo, Joseph, eds. (13 August 2018). Harrison's principles of internal medicine (20th ed.). New York: McGraw-Hill Education. ISBN 978-1-259-64403-0. OCLC 1029074059.
6. "Cafe Au Lait Spots", by William D James, MD
7. Cafe Au Lait Spots
8. Whyte, M. P.; Podgornik, M. N.; Zerega, J.; Reinus, W. R. (2000). "Café-au-lait spots caused by vitiligo in McCune-Albright syndrome". J Bone Miner Res. 15 (12): 2521–2523. doi:10.1359/jbmr.2000.15.12.2521. PMID 11127218. S2CID 43896568.
9. Arnsmeier, Sheryl L.; Riccardi, Vincent M.; Paller, Amy S. (1994). "Familial Multiple Cafe au lait Spots". Archives of Dermatology. 130 (11): 1425–1426. doi:10.1001/archderm.1994.01690110091015. PMID 7979446.
10. Friedman, J. M.; Adam, M. P.; Everman, D. B.; Mirzaa, G. M.; Pagon, R. A.; Wallace, S. E.; Bean LJH; Gripp, K. W.; Amemiya, A. (1993). "Neurofibromatosis 1". GeneReviews. PMID 20301288.
11. Scheinfeld, Noah S.; et al. (2011). "Laser Treatment of Benign Pigmented Lesions". Medscape Reference.
12. Lowell A. Goldsmith; et al., eds. (2012). Fitzpatrick's dermatology in general medicine (8th ed.). New York: McGraw-Hill Medical. pp. Chapter 239. ISBN 978-0-07-166904-7.

External links

• eMedicine