Coffee Au Lait Stains On Children: Should We Be Worried?
Café au lait spots are pale brown spots with a homogeneous appearance that occur on the skin of 25% of children. The amount of stains or their size will vary. In addition, they are harmless and normal, but their importance lies in the fact that they are likely to be considered one of the manifestations of type I neurofibromatosis .
What are latte stains?
This type of skin manifestation consists of dull, hyperpigmented patches that appear as a focused area of increased generation of melanin, the skin’s pigment.
As the child grows, the café au lait spots can grow together. They can even be found anywhere on the body, with greater preference for areas such as the trunk and limbs.
They are seen more frequently in black people, but this does not prevent records of their presence in people with lighter skin.
The size of each of these spots can range from 2 mm to more than 20 cm in diameter. In turn, they are usually lighter as soon as they appear and their hue will intensify over time.
Why do latte stains appear?
They can be congenital or they can develop over time. Café au lait spots are associated with different types of genetic syndromes. Some of them are as follows:
- Neurofibromatosis I.
- Neurofibromatosis II.
- McCune-Albright Syndrome.
- Legius Syndrome.
- Tuberous sclerosis.
In children with more than 6 café-au-lait spots, with a diameter greater than 5 mm before puberty, or greater than 15 mm in post-puberty, neurofibromatosis I should be suspected.
Neurofibromatosis I or von Recklinghausen’s disease
Neurofibromatosis I is the most common of all neurofibromatosis. It is estimated that it appears in about 1 in every 3500 births.
It has a genetic origin, due to a mutation in the NF1 gene, with an autosomal dominant pattern of inheritance. According to an analysis by the Spanish Association of Pediatrics , the presence of café au lait spots is one of the criteria for establishing your diagnosis, along with two of the following criteria:
- Plexiform neurofibroma.
- Ephelides in the axillary or inguinal region.
- 6 or more latte stains.
- Optical glioma.
- A distinctive bone lesion.
- 2 or more Lisch nodules.
- A first-degree relative with the above criteria.
There may also be learning difficulties, attention deficit disorder, under-average height, precocious puberty, hypertension, scoliosis, headaches, and oversized headaches.
The symptoms of neurofibromatosis can be mild in some children, but severe in others. In turn, there may be different characteristics of the disease between members of the same family.
Is it possible to avoid latte stains?
As for preventing the appearance of this type of benign and pigmented lesion, there are no recommendations. This is because they are not like nevi, which arise as a result of constant exposure to the sun.
On the contrary, some are congenital or appear during the first days of life, a period when babies should not receive direct sunlight.
Treatment of coffee with milk stains
The café au lait spots do not undergo a malignant transformation over time. Therefore, no treatment is needed for them, unless they generate an aesthetic discomfort in those who present them.
Laser as a therapeutic option
In cases where the start of therapy is proposed, laser treatment is the first option. It can generate a partial lightening of the stain, but recurrence is not ruled out.
This type of treatment requires several sessions and the risks are the same as any laser procedure:
- Transient or permanent hyperpigmentation.
- Hypopigmentation.
- Skin sensitivity.
- Residual scars.
The sessions to perform this procedure usually last a few minutes and, in most cases, it is usually to wait between 6 and 8 weeks for the next session to be performed.
When should the pediatrician be consulted?
If brown spots appear, it is necessary to schedule a medical appointment so that the specialist can determine if they are isolated lesions or if they are part of a genetic syndrome. So, the doctor will carry out a questionnaire according to the background. At the same time, he will also order the necessary and corresponding tests to rule out all possible differential diagnoses.
If there are a small number of café-au-lait spots, only the pertinent monitoring of their evolution (size and number) will be done and parents will be instructed to always be aware of any new symptoms related to any of the diseases that manifest them.
