Cafe Au Lait Birthmark Treatment

CALM or cafe au lait macule birthmarks are commonly treated at the Melasma Clinic. Most cases respond to pigment lasers. Lasers provide scarless removal with quick recovery times. A series of 2-4 sessions are required for best results. Treatments are partially subsidized by Medicare. 

Recovery

3-5 days

Results

Good

Treatment Time

2-4 minutes

Aftercare

SPF

Pigment removal success rate 75-80%

The science of CALM birthmark treatments

  • This is the most common ‘brown’ birthmark
  • This birthmark can be effectively treated with pigment lasers
  • Treatments are partially covered under Medicare
  • Laser treatment is scarless with success rate of over 80%
  • Remission time is variable

Pigment lasers have revolutionized CALM birthmark treatments giving predictable results in over 80% of patients. 

What are cafe au lait birthmarks?

A cafe au lait macule is a common brown birthmark that presents at or shortly after birth. In most cases it measures 1 to 10 cm in diameter.  

It is extremely important to first ascertain the diagnosis as other birthmarks resemble CALM birthmarks.

What other birthmarks resemble CALM, & what do they imply?

Getting the diagnosis is the most important bit, sometimes it’s not that easy. A diagnosis will give you an idea if the birthmarks will respond to lasers, or if they are resistant. 

Naevus spilus looks like a CALM, but it has moles together with a CALM birthmark element. This birthmark is usually resistant to lasers. 

Becker’s naevi are thicker than CALM, often present later & may have excess hair within the area. This birthmark gets darker in adolescence. It does not respond well to lasers, so save your money.

Congenital melanocytic naevi are deeper than CALM & usually darker. They can respond variably to CO2 lasers, but require 8-16 sessions. 

What is the best way to treat CALM birthmarks?

Laser treatment is the best way to treat cafe au lait birthmarks. We use the very best pico & short pulse nano lasers, ensuring the most efficient, effective & safest treatments possible. 

Surgery is not performed for CALM birthmarks but may be considered for congenital melanocytic naevi. 

Treatmemt

Recovery

Scarring

Clearance rate

Pico laser 3-6 days Nil 80%
Surgery 7-14 days In all cases 100%

What is the treatment like?

Treatments are comfortable & fast, taking less than 2 minutes to perform. For comfort, we use numbing cream, cold air as well as mild sedation (for larger Cafe Au Lait Macules).

*We only encourage treatments in the mid teens. For children, sedation is required (which is not performed in rooms in Sydney). 

What is the recovery following laser for CALM?

2-5 days depending on the size of the birthmark. Here is what to expect-

  • First 1 hour: frosting or skin whitening. 
  • 1-2 days: redness with slight oozing.
  • 2-5 days: scabs & redness. 
  • 1-3 weeks: redness fading.

*Side effects such as pigment darkening are not uncommon in darker skin types, even using the very latest lasers.

How many sessions will it take to clear?

Typically 2-4 sessions, spaced 8 to 12 weeks apart. Less sessions for smaller CALM birthmarks in lighter skin types, more sessions for larger CALM spots in darker skin types. There is a partial Medicare rebate for CALM birthmarks. 

Can creams treat birthmarks?

Creams have a marginal effect on birthmarks as they occur in the deeper layers of skin. If you are going to invest in a cream, the best one is sunscreen. Creams are occasionally prescribed after laser to reduce the effects of post inflammatory hyperpigmentation.

Will CALMs return after treatment?

Once cleared the chances of recurrence depends on your genetics. 20% get lifelong cure, 80% have some form of recurrence. Remission periods range from 2 to 10 years. Surgery provides 100% removal, but at the expense of significant scarring. 

Are there any side effects of lasers?

Side effects are rare, with an increased incidence in darker skin types. They include –

  • Darkening of birthmarks
  • Hypopigmentation (lighter skin)
  • Crusting, persistent redness

At what age can you get a birthmark treated?

Most cafe au lait macules do not require treatment, however if they occur  in conspicuous areas such as the face or neck, laser treatments are a possibility. 

A good age to treat is 13 or above. There is no evidence that early treatment of CALM birthmarks gives a better prognosis (unlike port wine stains). 

*We do not treat birthmarks in children less than 13 as they most often require full sedation. This is done in a hospital setting.

Can cafe au lait birthmarks change to cancer?

No. Skin cancers such as melanoma do not occur in CALM birthmarks, hence no treatment nor follow up is required. Some birthmarks such as nevus spilus or congenital naevi have an increased risk of melanoma. 

Retinoids such as #tretinoin & retinol can be useful in addressing melasma pigmentation. Best applied at night due to photosensitivity
.
👉Vitamin C: can be used as an antioxidant or as a pigment corrector. Personally I prefer patients to apply in the am, under sunscreen
.
👉Azelaic acid: can be applied twice daily
.
👉Glycolic acid: can be potentially photosensitising (in theory, however practically not too much of an issue) 
.
👉Pigment correctors: generally applied in the PM, with exceptions such as #thiamidol, azelaic acid, HQ that can be applied twice daily depending on other skincare actives
.
👉Sunscreen: at least twice daily, AM & midday application
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #skincaretips #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist

Retinoids such as #tretinoin & retinol can be useful in addressing melasma pigmentation. Best applied at night due to photosensitivity
.
👉Vitamin C: can be used as an antioxidant or as a pigment corrector. Personally I prefer patients to apply in the am, under sunscreen
.
👉Azelaic acid: can be applied twice daily
.
👉Glycolic acid: can be potentially photosensitising (in theory, however practically not too much of an issue)
.
👉Pigment correctors: generally applied in the PM, with exceptions such as #thiamidol, azelaic acid, HQ that can be applied twice daily depending on other skincare actives
.
👉Sunscreen: at least twice daily, AM & midday application
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #skincaretips #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist
...

139 4
Here’s a tip, you don’t need to spend $$$ for a good formulation of azelaic acid
.
👉Azelaic acid: can reduce inflammation, acne, treat rosacea & is a great pigment corrector. It is our formulation of choice for some, but not all cases of #melasma pigmentation. It is also useful for PIH due to acne as it reduces acne, inflammation & pigmentation👍🏻
.
👉Concept: add ingredients specific to their tasks, maximal concentration without skin irritation, titrated according to skin’s sensitivity
.
👉Azclear: has 20% azelaic acid. Other brands? Go for it, you’re paying more for marketing & BS. Take note, this is an unsponsored post
.
🎬Action: For skin care tips, please consult our dermal clinicians & nurses.The Clinic’s aim is to solve a problem, not sell you products

.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney🇦🇺
.
#melasma #melasmaclinic #azelaicacid #azclear #drdavinlim #dermatologistsydney @azclear

Here’s a tip, you don’t need to spend $$$ for a good formulation of azelaic acid
.
👉Azelaic acid: can reduce inflammation, acne, treat rosacea & is a great pigment corrector. It is our formulation of choice for some, but not all cases of #melasma pigmentation. It is also useful for PIH due to acne as it reduces acne, inflammation & pigmentation👍🏻
.
👉Concept: add ingredients specific to their tasks, maximal concentration without skin irritation, titrated according to skin’s sensitivity
.
👉Azclear: has 20% azelaic acid. Other brands? Go for it, you’re paying more for marketing & BS. Take note, this is an unsponsored post
.
🎬Action: For skin care tips, please consult our dermal clinicians & nurses.The Clinic’s aim is to solve a problem, not sell you products

.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney🇦🇺
.
#melasma #melasmaclinic #azelaicacid #azclear #drdavinlim #dermatologistsydney @azclear
...

160 13
Not the definitive list as there are many variables depending on the concentration of ‘actives’ & the formulation
.
👉Clinic: HQ & cysteamine
.
👉Home: Azelaic acid is one of our favs, vitamin C equally so
.
😎Davin Lim 
Dermatologist 
Brisbane | Sydney🇦🇺
.
#davinlim  #skinlightening #skinbrightening  #pigmentationsolutions #dermatologistsydney #pigmentationclinic #azeliacacid

Not the definitive list as there are many variables depending on the concentration of ‘actives’ & the formulation
.
👉Clinic: HQ & cysteamine
.
👉Home: Azelaic acid is one of our favs, vitamin C equally so
.
😎Davin Lim
Dermatologist
Brisbane | Sydney🇦🇺
.
#davinlim #skinlightening #skinbrightening #pigmentationsolutions #dermatologistsydney #pigmentationclinic #azeliacacid
...

121 8
🙏🏼Please do not prescribe irritating topicals for dark circles if you are unsure of the cause
.
👉please don’t upsell skincare that is potentially irritating. It often worsens pigment causing post-inflammatory hyperpigmentation, making treatments much harder, as in this case. It clouds the underlying pathology & accentuates the condition. 
.
👁️Dark circles: POH or periocular hyperpigmentation is mostly multifactorial, genetics (constitutional), irritation (PIH), congestion - vascular, shadowing (true tear trough), rubbing (lichenification), maturational, AN associated etc. 
.
👉Treatments: treat the cause, genetic or constitutional causes are difficult. If unsure, prescribe some Azelaic acid 10%. This patient was prescribed a mix of ascorbic acid, as well as retinol, which resulted in skin irritation, rubbing & lichenification. I know many clinicians in corporate clients have KPIs to meet, but consider your skincare prescriptions carefully please 🙏🏼 
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney 🇦🇺
.
#darkcircles #darkcircletreatment #darkcircleremedy #darkcircleDIY #darkcirclehomeremedies

🙏🏼Please do not prescribe irritating topicals for dark circles if you are unsure of the cause
.
👉please don’t upsell skincare that is potentially irritating. It often worsens pigment causing post-inflammatory hyperpigmentation, making treatments much harder, as in this case. It clouds the underlying pathology & accentuates the condition.
.
👁️Dark circles: POH or periocular hyperpigmentation is mostly multifactorial, genetics (constitutional), irritation (PIH), congestion - vascular, shadowing (true tear trough), rubbing (lichenification), maturational, AN associated etc.
.
👉Treatments: treat the cause, genetic or constitutional causes are difficult. If unsure, prescribe some Azelaic acid 10%. This patient was prescribed a mix of ascorbic acid, as well as retinol, which resulted in skin irritation, rubbing & lichenification. I know many clinicians in corporate clients have KPIs to meet, but consider your skincare prescriptions carefully please 🙏🏼
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney 🇦🇺
.
#darkcircles #darkcircletreatment #darkcircleremedy #darkcircleDIY #darkcirclehomeremedies
...

148 9

Dr Davin Lim

645K subscribers

How to treat PIGMENTATION

If I can identify the cause of pigmentation, chances are I can treat it. This can only be achieved with careful real time examination…

More of our mostFrequently asked questions

Can surgery be performed?

What is the cost of treatment?

Can chemical peels treat birthmarks?

Are pico lasers the best option for CALM birthmarks?

What are other conditions that may look like CALM birthmarks?

 How does Picosure differ from Picoway for CALM?

How are café au lait macules diagnosed?

What are the symptoms of café au lait macules?

What causes café au lait macules?

Who performs the procedure?

What are natural ways to treat café au lait macule birthmarks?

A SummaryTreating cafe au lait birthmarks

Dr Davin Lim | Dermatologist
The Melasma Clinic, Brisbane | Sydney

Cafe au lait macules are common birthmarks present at, or around birth. Most are small & do not require treatment. They are more commonly seen in Africans followed by Hispanics than other races.

Though the older literature suggests that only 50% respond to lasers, we see up to 80-85% response rates. Most require a series of 2-4 sessions, spaced 6 to 12 weeks apart. I prefer the older nano short PD lasers over pico lasers for CALMs, especially if they are of low contrast or if they occur in lighter skin types. Pico lasers are preferred in darker skin types, not because of better clearance rates, but because they are inherently safer.