Response to Laser Treatment of Café au Lait Macules Based on Morphologic Features

Abstract

IMPORTANCEResponse to laser treatment for café au lait macules (CALMs) is inconsistent and difficult to predict. OBJECTIVE To test the hypothesis that irregularly bordered CALMs of the "coast of Maine" subtype respond better to treatment than those of the smooth-bordered "coast of California" subtype. DESIGN, SETTING, AND PARTICIPANTSThis retrospective case series included patients from 2 multiple-clinician US practices treated from 2005 through 2016. All patients had a clinical diagnosis of CALM and were treated with a Q-switched or picosecond laser. A total of 51 consecutive patients were eligible, 6 of whom were excluded owing to ambiguous lesion subtype. Observers were blinded to final patient groupings.EXPOSURES Treatment with 755-nm alexandrite picosecond laser, Q-switched ruby laser, Q-switched alexandrite laser, or Q-switched 1064-nm Nd:YAG laser.MAIN OUTCOMES AND MEASURES Main outcome was grade in a visual analog scale (VAS) consisting of 4 levels of treatment response: poor (grade 1, 0%-25% improvement), fair (grade 2, 26%-50% improvement), good (grade 3, 51%-75% improvement), and excellent (grade 4, 76%-100% improvement).RESULTS Forty-five patients were included in the series, 19 with smooth-bordered lesions and 26 with irregularly bordered lesions. Thirty-four (76%) of the participants were female; 33 (73%) were white; and the mean age at the time of laser treatment was 14.5 years (range, 0-44 years). Smooth-bordered lesions received a mean VAS score of 1.76, corresponding to a fair response on average (26%-50% pigmentary clearance). Irregularly bordered lesions received a mean VAS score of 3.67, corresponding to an excellent response on average (76%-100% clearance) (P < .001). CONCLUSIONS AND RELEVANCECALMs with jagged or ill-defined borders of the coast of Maine subtype tend to respond well to laser treatment, whereas those with smooth and well-defined borders of the coast of California subtype tend to have poor response. Clinicians using Q-switched or picosecond lasers to treat CALMs can use morphologic characteristics to help predict response and more effectively manage patient expectations.

Treatment of Café‐Au‐Lait Spots Using Q‐Switched Alexandrite Laser: Analysis of Clinical Characteristics of 471 Children in Mainland China

“…). This is consistent with the results of Q‐switched Alexandrite laser treatments in adults . However, because of incomplete data, this study was unable to show any statistical evidence of this association; this is a limitation of the study.…”

A Systematic Review of Picosecond Laser in Dermatology: Evidence and Recommendations

“…One to four treatment sessions were administered and the investigators reported that 15/16 patients achieved significant to complete resolution of their lesions with one non‐responder [17]. CALMs with jagged, ill‐defined borders of the coast of Maine subtype may respond better to laser treatment [92].…”

The Treatment of Infantile Cafe Au Lait Spot Using Dr. Hoon Hur’s Golden Parameter Therapy with a High Fluence 1064nm Q-Switched Nd: Yag Laser

“…Recently, traditional laser treatments such as ruby laser, alexandrite laser and 532nm Potassium Titanyl Phosphate (KTP) laser have been widely used in the CALS treatment. However, traditional laser treatments were somewhat unsatisfactory since they produced purpurae, crusts, PIH, mottled hypopigmentation and scarring [4][5][6]. In particular, it is extremely difficult to treat infantile CALS without causing PIH [4][5][6].…”

“…Treatment for CALS is not necessary except for cosmetic purposes [1][2][3]. Especially, infantile CALS is very hard to treat with out causing any side effects and recurrences because an infant is too young to receive laser treatment [4][5][6]. Therefore, this study was undertaken to confirm the efficacy and safety of Dr. Hoon Hur's Golden Parameter Therapy (GPT) using a high fluence 1064nm Q-switched Nd:YAG laser (QSNL) for treating infantile CALS without any side effects and recurrences.…”