Is this Melasma or is it a Cafe Au Lait Spot? (photo)

Question

I have several spots like this on my face (this one is my forehead). I thought it was Melasma but recently had a dermal neurofibroma removed from my back (appeared in the last year). I also have inguinal freckling which I've had ever since I can remember. After reading about Neurofibromatosis, I'm starting to wonder if what I thought was Melasma is actually Cafe Au Lait spots. These spots have gotten worse over time. I also had some nerve pain in my hands and feet not too long ago.

Raffy Karamanoukian, MD, FACS · Answer

Melasma is common in this area. I would recommend Melarase AM, Melarase PM, Melapads, and Replenish in addition to some light chemical peels. Best, Dr. KaramanoukianLos Angeles

Jason Emer, MD · Answer

Melasma requires a series of treatments.  Sometimes tattoo laser or fractional RUBY can help but low level laser is often required with microneedling/PRP.  I suggest lightening skin care and sunscreen with peels in between lasers.  Please see an expert for a combination treatment.  Best, Dr. Emer.

Harold J. Kaplan, MD · Answer

Hello CNN.  If you have several of these spots on the face, it's unlikely that they are birthmarks, especially if you did not have them at birth.  To treat Melasma, we use a high strength hydroquinone at 8%.  To see the before and after photos of our other Los Angeles Melasma patients, click on the link below.

Hratch Karamanoukian, MD, FACS · Answer

The features of this 'lesion' of your forehead is highly suggestive of melasma. Plus, it is not likely that you were born with melasma. It is acquired.The Cafe au lait lesion is a 'birthmark'.See our melasma center in Santa Monica for care. Best

Justine Kluk, MBChB, MRCP · Answer

Hi. Your photo looks like melasma, but I would suggest arranging a face to face dermatology consult given your medical history and the other features you describe. Best wishes.

Davin Lim, MBBS, FACD - Account Suspended · Answer

The picture shows that you have melasma and not a CALM or Cafe Au Lait Macule. Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams.

In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help.

All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia

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