20 Years Old Male with Multiple Hyperpigmented Macules on Trunk

  • Pawan Kumar
Part of the Clinical Cases in Dermatology book series (CLIDADE)


A 20 year old male presented with multiple asymptomatic hyperpigmented macules since first year of life without any systemic complaints. Based on clinical information diagnosis of Café au lait macules (CALM) was made. CALMs are localized epidermal melanocytic flat lesions, named after their typical coffee-and-milk hue. It can be notice in any body part, incidence being 5% among caucasians. CALM lesions are fairly well demarcated, light to dark brown hyperpigmented macules, size varying from 2 mm to 20 cm, usually a clinical diagnosis, solitary lesions can be a simple benign birthmark, but multiple lesions should alarm us to look for systemic associations like neurofibromatosis, Mc-cune Albright syndrome. The most common type of café ua lait macule is light brown pigmented macule, has fairly regular and clearly demarcated margins (“coast of California”). There is a second, less frequent type of CALM that has a much more irregular margin (“coast of Maine”). It is a clinical diagnosis. Treatment solely based on patient’s need, simple reassurance is the usual approach followed, if cosmetically disfiguring then different options tried are Q switched ND: YAG laser, Q-switched ruby laser, Q-switched alexandrite laser, erbium-doped YAG, and pulsed-dye laser.


Café-au-lait macule Hyperpigmentation Neurofibromatosis Mc-cune Albright syndrome 


  1. 1.
    Cohen JB, Janniger CK, Schwartz RA. Café au lait spots. Paediatr Dermatol. 2000;66:22–4.Google Scholar
  2. 2.
    Tekin M, Bodurtha JN, Riccardi VM. Café au lait spots: the pediatrician’s perspective. Pediatr Rev. 2001;22:82–90.CrossRefGoogle Scholar
  3. 3.
    Shah KN. The diagnostic and clinical significance of café-au-lait macules. Pediatr Clin North Am. 2010;57:1131–53.CrossRefGoogle Scholar
  4. 4.
    Wimmer K, Kratz CP, Vasen HF, Caron O, Colas C, Entz-Werle N, et al. Diagnostic criteria for constitutional mismatch repair deficiency syndrome: suggestions of the European consortium ‘care for CMMRD’ (C4CMMRD). J Med Genet. 2014;5:355–65.CrossRefGoogle Scholar
  5. 5.
    Belkin DA, Neckman JP, Jeon H, Friedman P, Geronemus RG. Response to laser treatment of Café au lait macules based on morphologic features. JAMA Dermatol. 2017;153(11):1158–61.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Pawan Kumar
    • 1
  1. 1.Kempegowda Institute of Medical SciencesBengaluruIndia

Personalised recommendations