Diagnosis

Café au Lait Mark - Before and After Photos using
a Q-Switch Laser (Courtesy of Livingstone Hospital)

Diagnosis

As the largest and most exposed organ of the human body, it is hardly surprising that our skin is also sensitive to damage and change – particularly pigmentary problems. With time, most people acquire pigmentary lesions of some kind or another, whilst others are born with congenital pigmented skin lesions (birthmarks).

Brief descriptions are provided below but it is highly advisable that diagnosis is confirmed by a suitably qualified physician before commencing treatment.

What are café-au-lait spots?

Café au lait spots are usually present at birth but can appear in the first few years of life. They are flat lesions that are typically the colour made by adding milk to coffee, hence their name. They may vary in size from a few millimeters, as in axillary freckling, to large macules that measure more than 10 cm in size. Many children have one or two of these, but if more than six have developed by the time the child is five, they may have a genetic disorder called neurofibromatosis. Café au lait spots can be treated effectively with a Q-Switch Laser, but multiple treatments are necessary to achieve clearance, and repigmentation can occur.

What are ephelides?

The common name for these is freckles. They are small, discrete pale brown pigmented specks typically seen on sun exposed skin. They are most common in fair skinned individuals and can be treated with IPL or the Q Switch laser.

What are solar lentigines?

Commonly referred to as sun spots or age spots, a solar lentigo is a brown macule occurring as a result of UV damage, seen most commonly on the face and the backs of the hands. Mutiple lesions are termed lentigines. They can be treated with IPL or the Q Switch laser and post treatment they often form a slight superficial crust and flake off. A high factor sunscreen is recommended to prevent reoccurrence.

What is seborrheic keratoses?

These are benign, wart-like growths in the outer layer of skin. There may be just one lesion, although typically they occur in clusters. They are usually mid to dark brown but can vary in colour from light tan to black. They also vary in size from a few millimetres in diameter to larger than 2 centimetres. Once diagnosis has been confirmed by a medical practitioner, they can be treated with IPL or Q Switch Laser.

What is Naevus of Ota/Ita?

Naevus of Ota is a dermal lesion, which presents as a blue or grey patch on the face around the eye that is usually present from birth and unilateral. Naevus of Ita is a similar lesion affecting the upper chest and shoulder rather than the face. Both conditions may be speckled or uniform and are more common in people from the Far East. These lesions can be treated with the Q Switch Laser.

What are congenital melanocytic naevi?

Congenital melanocytic naevi (CMN) are relatively large brown or black moles that are present at birth. They are fairly common and are caused by an overgrowth of pigment cells in the skin. Most CMN become proportionally smaller and less obvious with time, although they may darken during puberty or become bumpy or hairy. In rare cases, they fade and may disappear altogether.

What are mongolian spots?

Mongolian spots are blue-grey or bruised-looking birthmarks commonly seen in darker-skinned people that are present at birth. The marks usually appear over the lower back or buttocks, but can also appear elsewhere on the body or limbs. Mongolian spots are usually a few centimetres in diameter, although they can be larger. They may persist for months or years, but usually disappear by the age of four. They are completely harmless and do not need treatment.

What can’t be treated?

Moles, melasma, and post-inflammatory hyperpigmentation.