Multiple Flat Light-Brown Marks on Skin

Another names
Types
Causes
Symptoms and signs
Diagnostic tests
Non-pharmacological treatments (therapies & others)
Drug treatments
Dietary molecular supplements
Immunity booster / regenerative / stem-cell drugs
Procedures/surgeries
Preventions
When to see a doctor
What to eat and what to avoid
Frequently asked questions

Multiple Flat Light-Brown Marks on Skin are harmless areas of increased skin pigment (melanin) that look like smooth-edged, flat, light-brown patches. They can be present at birth or appear in early childhood and may increase in size and number as a child grows. One or two marks are very common and usually do not mean illness. In contrast, many marks—especially six or more, larger than about 0.5 cm in children or 1.5 cm in teens/adults—can be a clue to conditions like NF1 or Legius syndrome and should prompt a medical check-up. NCBI+2DermNet®+2

Café-au-lait macules are flat, harmless skin patches that look light-brown to dark-brown, like “coffee with milk.” They have smooth edges, do not itch or hurt, and are usually present at birth or appear in early childhood. One or a few spots are common and benign. However, having many spots can be a clue to a genetic condition, so counting and measuring them is important for children. These marks do not turn into cancer. Treatment is usually not needed unless someone wants cosmetic lightening. Lasers can lighten many spots, but some return over time. Sun exposure can make them look darker because of melanin (skin pigment). DermNet®+2NCBI+2

A single or a few CALMs are common. But six or more CALMs (over 0.5 cm in children or over 1.5 cm in adolescents/adults) can be a sign to check for neurofibromatosis type 1 (NF1) or a small group of other genetic conditions (for example, Legius syndrome). If a child has six or more spots, or has freckling in the armpits or groin, or other NF1 features, they should be evaluated. DermNet®+3NCBI+3Mayo Clinic+3

Another names

These spots have several alternative names: “café-au-lait macules,” “café-au-lait spots,” “coffee-with-milk patches,” “CALMs,” and, historically, “von Recklinghausen spots” when they occur with neurofibromatosis type 1 (NF1). All these names describe the same basic look: flat, light- to medium-brown patches with smooth, clear borders. DermNet®

Types

1) Solitary vs. multiple. A single patch is common and usually benign. Multiple patches raise the chance of an underlying genetic cause, especially if they appear early and keep increasing. NCBI

2) Typical vs. atypical border. Typical café-au-lait macules have smooth, “coast-of-California” borders; atypical ones can have more jagged “coast-of-Maine” edges and may be seen in certain syndromes. DermNet®

3) Generalized vs. segmental. Generalized means spots appear on both sides of the body. Segmental (or mosaic) means spots cluster in one region or follow a “strip” on one side, reflecting mosaic genetic changes in that patch of skin. NCBI

4) Isolated (non-syndromic) vs. syndromic. Isolated CALMs occur without other health problems. Syndromic CALMs occur with other features (like freckling in skin folds, bone changes, or endocrine issues) as part of a genetic condition. NCBI

Causes

Below are the most common and important reasons someone may have multiple café-au-lait-type marks. Some are harmless; others are part of well-known genetic conditions. Not everyone with these conditions will have all signs.

Isolated/normal variation. Some people naturally have several café-au-lait patches with no illness at all. This is more common in people with darker skin tones and usually stays stable over time. NCBI
Neurofibromatosis type 1 (NF1). A genetic condition that often begins with multiple café-au-lait macules and freckling in the armpits/groin; later, benign nerve-sheath tumors (neurofibromas) and learning or bone issues may appear. Six or more CALMs is a key diagnostic sign. NCBI
Legius syndrome (SPRED1). Looks a lot like NF1 in the skin: multiple café-au-lait macules and often fold-freckling, but typically no neurofibromas or NF1-type tumors. Some people have macrocephaly or ADHD/learning issues. NCBI
McCune–Albright syndrome (MAS). Causes large, irregular-border café-au-lait patches (often one-sided), bone fibrous dysplasia, and hormonal problems like early puberty or thyroid overactivity; caused by mosaic GNAS mutations. NCBI+1
Segmental (mosaic) NF1. NF1 features (including CALMs) limited to one body region due to mosaicism; other parts of the body may be unaffected. NCBI
Noonan syndrome with multiple lentigines (formerly LEOPARD). Can show numerous dark macules (lentigines) and sometimes café-au-lait patches, with heart and growth issues. (Considered when freckling/lentigines dominate and NF1 testing is negative.) NCBI
Fanconi anemia. A rare bone-marrow failure disorder; some patients have café-au-lait macules along with short stature and thumb or kidney anomalies. (CALMs are a clue, not the main feature.) NCBI
Bloom syndrome. A DNA-repair condition with growth deficiency and sun-sensitive skin changes; café-au-lait-like patches may occur alongside telangiectasias and infections. NCBI
Ataxia-telangiectasia. A neurodegenerative, immune-related disorder with cerebellar signs and conjunctival telangiectasias; some patients show café-au-lait-type pigmentation. NCBI
Constitutional mismatch repair deficiency (CMMRD). A serious childhood cancer-predisposition syndrome; multiple CALMs can mimic NF1 but there is also a high risk of early cancers. NCBI
Tuberous sclerosis complex (TSC). Better known for ash-leaf hypopigmented macules and facial angiofibromas, but some individuals can also have café-au-lait-like patches. Consider when seizures or kidney/brain findings coexist. NCBI
Silver–Russell syndrome. A growth disorder; pigmentary lesions including café-au-lait may be reported along with triangular face and limb asymmetry. NCBI
Turner syndrome. Some girls have scattered pigmentary macules including café-au-lait spots in addition to short stature and cardiovascular anomalies. NCBI
Watson syndrome (NF1 variant). Shares features with NF1 including café-au-lait macules; often includes pulmonary artery stenosis and short stature. NCBI
Noonan syndrome (RAS-MAPK pathway). Pigmentary changes including café-au-lait macules can occur; look for characteristic facial features and heart defects. NCBI
Mixed/overlapping pigmentary disorders. Some people have CALMs with other lesions (e.g., lentigines, hypopigmented macules), which can guide testing toward specific genes. NCBI
Physiologic post-inflammatory hyperpigmentation mistaken for CALMs. Flat brown patches after eczema or injury can look similar; a clinician can tell by history and borders. DermNet®
Medication- or chemical-related hyperpigmentation that mimics CALMs. True CALMs are not caused by medicines, but some drugs/chemicals produce flat brown patches that can be confused with them. A careful history helps. NCBI
Congenital melanocytic nevi (subtle, flat variants) mistaken for CALMs. These are mole-type lesions present at birth; dermoscopy/histology helps distinguish them. DermNet®
Other rare genetic syndromes. A long list (e.g., NF2, various RASopathies) may include café-au-lait-like pigmentation among many findings; the pattern plus family history guide testing. NCBI

Symptoms and signs

Most café-au-lait patches do not cause symptoms—they are flat and painless. Symptoms, when present, come from the underlying condition associated with multiple marks.

Flat, light-brown patches with smooth borders. They are even in color, sharply edged, and do not itch or hurt. DermNet®
Increase in number or size with growth. New patches may appear during childhood and enlarge proportionally as the child grows. NCBI
Armpit or groin freckling. Tiny brown specks in skin folds often accompany multiple CALMs in NF1 or Legius syndrome. NCBI+1
Soft skin bumps (neurofibromas) later in life. Seen in NF1; they are benign nerve-sheath tumors on or under the skin. NCBI
Iris freckles (Lisch nodules). Small pigmented spots on the colored part of the eye in NF1; usually found by an eye doctor. NCBI
Learning or attention difficulties. Some children with NF1 or Legius have school or attention problems. NCBI+1
Bone changes. Bowing of long bones, scoliosis, or fibrous dysplasia (especially in MAS). NCBI+1
Head size larger than average (macrocephaly). Common in Legius syndrome and sometimes NF1. NCBI
Early puberty or other hormonal issues. Classic for MAS due to endocrine overactivity. NCBI
Headache or vision change (rare). Can occur if NF1 is complicated by optic pathway glioma—this is uncommon but important. NCBI
Skin fold freckling without tumors. Suggests Legius syndrome rather than NF1 when neurofibromas are absent. NCBI
One-sided, large, irregular patches. Points toward mosaic conditions such as MAS or segmental NF1. NCBI+1
Short stature or growth issues. Seen in several syndromes including NF1 and Fanconi anemia. NCBI+1
Seizures (if another syndrome is present). For example, MAS can be associated indirectly via endocrine or structural issues, and other neurocutaneous disorders can co-occur; seizures are not caused by CALMs themselves. NCBI
Completely asymptomatic course. Many people simply have the patches with no health problems at all. NCBI

Diagnostic tests

Doctors do not test every person with a few marks. They focus on history, physical exam, and targeted tests when many spots are present or when other features raise concern. Below are widely used, practical steps.

A) Physical examination (what the clinician sees and measures)

Full skin inspection. The doctor counts patches, measures size, checks borders, and notes distribution. Six or more typical CALMs is a key red flag for NF1 consideration. DermNet®+1
Skin-fold check (armpits/groin). Looking for speckled freckling that often accompanies CALMs in NF1 and Legius syndrome. NCBI+1
Family skin survey. A quick look (or history) for similar patches or NF1 features in parents/siblings helps with inherited conditions. NCBI
Growth and development review. Plotting height/weight/head size and asking about school/behavior screens for syndromic clues. NCBI+1
Targeted eye exam (in clinic). Checking visual acuity and pupillary responses; abnormal findings (or age milestones) trigger referral to ophthalmology for slit-lamp evaluation of Lisch nodules. NCBI

B) Manual/bedside tools (simple instruments used during exam)

Dermoscopy. A handheld scope helps confirm uniform pigment, smooth borders, and distinguishes CALMs from moles or post-inflammatory marks. DermNet®
Wood’s lamp exam. Ultraviolet light can make subtle lesions more obvious on light skin and helps differentiate other pigment problems. DermNet®
Diascopy (glass-slide test). Gentle pressure helps ensure color is due to pigment (won’t blanch like blood vessels), supporting a CALM diagnosis. DermNet®
Palpation for neurofibromas. Feeling for soft, button-like bumps under or on the skin suggests NF1 rather than Legius syndrome. NCBI
Scoliosis/limb exam. Quick checks for spine curve or limb bowing that can accompany NF1 or MAS. NCBI+1

C) Laboratory and pathological tests

Targeted genetic testing for NF1. Blood or saliva testing can detect the vast majority of NF1 gene variants; helpful when clinical signs are incomplete or before tumors appear. A negative test does not fully exclude mosaic/segmental NF1. NCBI
SPRED1 testing (Legius syndrome). Recommended when a person has multiple CALMs (± fold freckling) but no neurofibromas or NF1 tumor features. NCBI
GNAS mutation analysis (for MAS). Often requires testing affected tissue (like bone) because the mutation is mosaic and may not be found in blood. NCBI
Syndrome-specific panels. When the picture is unclear, clinicians may order a pigmentary/rasopathy gene panel that includes NF1, SPRED1, and related genes. NCBI
Biopsy (rare). Most CALMs do not need biopsy; when done, pathology shows increased basal melanin without melanocyte proliferation, helping distinguish from nevi. DermNet®

D) Electrodiagnostic and neurophysiologic tests (used only for selected complications)

EEG (electroencephalogram). Not for CALMs themselves, but used if a person with syndromic features has seizures (e.g., some MAS or other neurocutaneous disorders). NCBI
Evoked potentials (visual/auditory). Rarely used; may support evaluation when there are concerns about optic pathway involvement or brainstem pathways in complex NF1 cases. (Imaging is primary.) NCBI

E) Imaging tests (only when indicated by symptoms/signs)

Slit-lamp ophthalmology exam. A specialized lighted microscope exam of the eyes to detect Lisch nodules or other iris changes linked to NF1. NCBI
MRI of brain and orbits. Ordered if there are visual symptoms, persistent headaches, or other neurologic signs suggesting an optic pathway glioma or related NF1 complications. (Not routine for everyone with CALMs.) NCBI
Skeletal imaging (X-ray or CT/MRI). Used when bone pain, bowing, scoliosis, or suspected fibrous dysplasia is present, especially in MAS. NCBI

Non-pharmacological treatments (therapies & others)

No cream or pill is FDA-approved specifically to erase CALMs. Non-drug options focus on reassurance, camouflage, sun protection, and procedural lasers. Evidence says lasers can work, but responses vary and recurrence can happen. Patch-testing is often advised. BioMed Central+1

Education & reassurance (≈150 words, Purpose, Mechanism).
Purpose: Reduce worry by explaining CALMs are benign birthmarks in most people. Mechanism: Knowledge lowers anxiety and prevents unnecessary procedures. Parents learn the “rule of six” and when to seek genetics input. Details: Explain that solitary CALMs are common and harmless; they don’t become cancer. Explain that if a child has many spots, doctors check for NF1 using clear size/number rules and look for other features. Reassurance helps families choose watchful waiting rather than risky treatments. DermNet®+1
Sun protection (daily broad-spectrum sunscreen, clothing).
Purpose: Reduce darkening and contrast with surrounding skin. Mechanism: UV light triggers melanin production, making spots look darker. Details: Use broad-spectrum SPF, hats, clothing, shade, and avoid midday sun; this does not remove the spot but can help it blend better with nearby skin. Medscape
Cosmetic camouflage (make-up/skin-tinted products).
Purpose: Immediate blending for visible areas. Mechanism: Pigments optically mask color difference. Details: Color-correcting primers or high-coverage concealers chosen to match skin undertone can make patches far less noticeable without medical risk. Verywell Health
Dermatology assessment for treatment planning.
Purpose: Confirm the diagnosis and discuss options. Mechanism: Clinical exam distinguishes CALMs from freckles, lentigines, or other lesions and checks for NF1 signs. Details: A dermatologist can also advise on realistic laser outcomes and recurrence. American Academy of Dermatology
Periodic monitoring in children.
Purpose: Early detection of syndromic associations. Mechanism: Tracking number/size plus any new NF1 features (axillary/groin freckling, neurofibromas, vision or bone problems). Details: Counts and measurements during well-child visits help decide if genetics referral is needed. NCBI
Genetics referral when criteria met.
Purpose: Confirm/rule out NF1 or Legius. Mechanism: Genetic testing and syndromic evaluation when ≥6 typical CALMs or other suggestive signs. Details: Early diagnosis guides follow-up for eyes, learning, bones, and nerves. NCBI+1
Psychological support (especially for visible facial lesions).
Purpose: Body-image support and coping skills. Mechanism: Counseling reduces distress and improves quality of life. Details: Simple acceptance strategies and cosmetic tips can be very effective; procedures are optional. Verywell Health
Test spots before laser.
Purpose: Predict response and avoid side effects (especially in darker skin tones). Mechanism: Small-area trials gauge pigment change and post-inflammatory hyperpigmentation risk. Details: Professional guidelines and studies recommend patch-testing. PubMed
Q-switched alexandrite laser (≈755 nm).
Purpose: Break pigment particles to lighten the macule. Mechanism: Short, high-energy pulses target melanin (selective photothermolysis). Details: Studies in children show it can be safe and effective; multiple sessions often required; recurrence can occur. Wiley Online Library+1
Q-switched 1064 nm Nd:YAG laser.
Purpose: Lighten deeper pigment with longer wavelength. Mechanism: Targets melanin with deeper penetration; may suit darker skin types. Details: Meta-analyses and clinical studies note efficacy; recurrence rate across lasers is ~13% pooled, with high variability. PMC+1
Picosecond lasers (e.g., 755 nm, 1064 nm, 730 nm).
Purpose: Similar to Q-switched but with even shorter pulses; may have fewer adverse effects. Mechanism: Photomechanical effect shatters pigment more efficiently. Details: Recent studies show comparable efficacy to nanosecond lasers, sometimes with fewer complications. PubMed+2PubMed+2
Fractional non-ablative resurfacing (e.g., thulium).
Purpose: Improve pigment by creating micro-channels that remodel epidermis. Mechanism: Fractional photothermolysis promotes turnover and dispersion of melanin. Details: Case reports suggest benefit in resistant cases. JKSLMS
Strict photoprotection after procedures.
Purpose: Prevent rebound darkening and PIH. Mechanism: Post-laser skin is vulnerable to UV-induced pigment. Details: Use SPF, clothing, and avoid sun for weeks after sessions per clinician advice. PubMed
Expectations setting about recurrence.
Purpose: Avoid disappointment. Mechanism: CALMs can re-pigment as melanocytes recover; pooled recurrence ~13%, but estimates vary. Details: Maintenance or repeat sessions may be needed. PMC
Avoid unregulated “skin-lightening” products.
Purpose: Reduce risk of mercury, steroids, or illegal ingredients. Mechanism: The FDA warns many OTC “skin lighteners” are misbranded/unsafe after regulatory changes; prescription oversight is safer. Details: Use only clinician-prescribed products. U.S. Food and Drug Administration
Color-matching wardrobe/hairstyles.
Purpose: Cosmetically de-emphasize visible patches. Mechanism: Contrast reduction draws the eye away from the lesion. Details: Simple practical styling can help self-confidence. (General supportive strategy consistent with cosmetic management guidance.) Verywell Health
High-quality photography for follow-up.
Purpose: Track change. Mechanism: Standardized photos show response to sun or procedures. Details: Helps decide if further care is needed. BioMed Central
Avoid harsh bleaching DIY regimens.
Purpose: Prevent irritation, ochronosis, or burns. Mechanism: Strong agents without medical supervision can damage skin, especially darker tones. Details: FDA notes risks with non-approved OTC lighteners. U.S. Food and Drug Administration
Shared decision-making about treatment vs. acceptance.
Purpose: Balance benefits and risks. Mechanism: Many CALMs are best left alone; treatment is elective. Details: Dermatologists often advise observation unless spots cause distress. American Academy of Dermatology
School/family education handouts.
Purpose: Reduce stigma for children. Mechanism: Simple explanations prevent teasing and unnecessary worry. Details: Clarifies when to seek care (e.g., six or more spots) and that most are harmless. Mayo Clinic

Drug treatments

There are currently no FDA-approved drugs whose labeled use is to remove or fade café-au-lait macules. Because of U.S. law changes, OTC “skin-lightening” products are not legally marketed without an approved new drug application, and many products sold online are misbranded or unsafe. Therefore, I will not invent a list of “drugs for CALMs.” Instead, below I briefly explain several prescription products approved for other pigment problems (e.g., melasma, solar lentigines) and why they are off-label for CALMs, with FDA labeling sources where available. Always discuss with a dermatologist before any off-label use. U.S. Food and Drug Administration

Examples of labeled drugs for other hyperpigmentation (not CALMs):

Tri-Luma® (fluocinolone 0.01% / hydroquinone 4% / tretinoin 0.05%) — Approved for short-term treatment of moderate-to-severe melasma. Not approved for CALMs. Key risks include irritation and retinoid teratogenicity warnings; strict sun protection is required. Dose per label is nightly thin layer to melasma areas for limited duration. Mechanism: hydroquinone inhibits tyrosinase (melanin), tretinoin increases turnover, steroid reduces inflammation. Side effects: erythema, peeling, irritation, potential ochronosis with chronic hydroquinone misuse. FDA Access Data+2FDA Access Data+2
Mequinol 2% + tretinoin 0.01% solution (e.g., Solagé®) — Approved for solar lentigines, not for CALMs. Mechanism: mequinol is a phenolic melanin synthesis inhibitor; tretinoin boosts epidermal turnover. Use/Risks: local irritation, photosensitivity; strict photoprotection. (FDA label supports indication/risk—off-label for CALMs.) U.S. Food and Drug Administration
General note on hydroquinone in the U.S. — Since the CARES Act changes, OTC hydroquinone products are not approved; prescription oversight is required, and FDA warns about potentially harmful OTC “lighteners.” This underscores why unsupervised products should be avoided. U.S. Food and Drug Administration+1

Because these medicines are not indicated for CALMs and evidence is limited, dermatologists usually prioritize non-drug methods (camouflage, sun protection) and, if desired, laser-based procedures. BioMed Central

If you still want an off-label discussion tailored to you, I can outline risks/benefits after a dermatologist confirms the diagnosis and rules out syndromic causes.

Dietary molecular supplements

There is no good evidence that any vitamin, herb, or “molecular supplement” can specifically fade café-au-lait macules. Claims online are often unsupported. The safest advice is a balanced diet that supports general skin health: enough protein, fruits/vegetables, and hydration. Antioxidants like vitamins C and E support normal skin repair, but they do not erase CALMs. If you choose to use any supplement, discuss interactions with your clinician, especially if you are pregnant, breastfeeding, or taking medicines that affect blood clotting or the liver. Medscape

(If you want, I can suggest a general skin-healthy diet plan, but it will not remove CALMs.)

Immunity booster / regenerative / stem-cell drugs

There are no approved “immunity boosters,” regenerative medicines, or stem-cell drugs that remove café-au-lait macules. Marketing language using these terms for pigment lightening is not evidence-based and can be unsafe. In children with NF1, some medicines (for example, selumetinib for symptomatic plexiform neurofibromas) are used for tumors, not for CALMs, and will not lighten CALMs. Do not seek “stem-cell” injections or unregulated biologics for CALMs. NCBI

Procedures/surgeries

Q-switched alexandrite laser (755 nm).
Procedure: Short pulses target melanin to lighten the patch; multiple sessions. Why: Cosmetic lightening when a spot is very visible. Notes: Effective in many patients; test a small area first; recurrence possible. Wiley Online Library+1
Q-switched Nd:YAG laser (1064 nm).
Procedure: Deeper penetration; useful for darker skin tones. Why: Alternative when alexandrite is unsuitable. Notes: Efficacy shown; pooled recurrence around 13% across laser types; PIH risk exists. PMC
Picosecond lasers (e.g., 755/1064/730 nm).
Procedure: Ultra-short pulses fragment pigment; sometimes fewer side effects. Why: Option if prior nanosecond lasers caused irritation or limited response. Notes: Studies show comparable efficacy and potentially fewer adverse events. PubMed+2PubMed+2
Fractional non-ablative resurfacing.
Procedure: Creates micro-columns to remodel epidermis and disperse pigment. Why: Rescue strategy in resistant cases. Notes: Evidence is limited (case reports). JKSLMS
Surgical excision (rare).
Procedure: Cut out the patch and close the wound. Why: Usually avoided because scars can look worse than the spot; considered only for atypical lesions where diagnosis is uncertain. Notes: Most CALMs are diagnosed clinically and left alone. DermNet®

Preventions

You cannot prevent being born with CALMs; they are birthmarks. Focus on safe care. DermNet®
Daily sun protection (SPF, hats, shade) to avoid darkening. Medscape
Avoid unapproved OTC lighteners; many are misbranded/unsafe. U.S. Food and Drug Administration
See dermatology if your child has ≥6 spots or other NF1 signs. NCBI
Use cosmetic camouflage for special events instead of harsh bleaching. Verywell Health
Photograph spots a few times per year to track change. BioMed Central
Test spots before lasers to reduce side effects. PubMed
Follow all post-procedure sun rules strictly. PubMed
Avoid DIY chemical peels/abrasives on CALMs; risk of scarring and hyperpigmentation. (General safety consistent with dermatologic guidance.) Medscape
Get genetics advice if there’s a family history of NF1/Legius plus multiple CALMs. NCBI+1

When to see a doctor

Children: If there are six or more CALMs; if spots are large (over 0.5 cm in children), if there is armpit/groin freckling, bumps on nerves (neurofibromas), vision issues, learning/behavior concerns, bone pain/deformity, or family history of NF1. A pediatrician may refer to genetics. NCBI
Adults: If many CALMs are present (especially new ones), if there is any change that looks unusual, or if you want advice about cosmetic options. American Academy of Dermatology

What to eat and what to avoid

Eating does not remove CALMs. But a skin-healthy diet supports overall skin function and healing if you choose laser treatment. Eat plenty of colorful fruits/vegetables (vitamin C, carotenoids), sources of vitamin E and healthy fats (nuts, seeds, fish), lean proteins (repair), and whole grains (overall health). Drink water regularly. Avoid extreme diets, unregulated “skin-whitening” pills, and megadoses of antioxidants that can interact with medicines. Limit alcohol and avoid smoking, which harms skin repair. Always check supplements with your clinician. Medscape

Frequently asked questions

Are these spots dangerous?
No. CALMs are harmless birthmarks in most people. DermNet®
Can they turn into cancer?
No. They do not become cancer. DermNet®
Why do doctors count them in kids?
Because six or more can signal NF1 or a related syndrome and may need genetics evaluation. NCBI
Do they go away with age?
No. They usually stay; sun can make them look darker. American Academy of Dermatology
Will creams remove them?
No cream is FDA-approved to erase CALMs; some creams help other pigment problems only. U.S. Food and Drug Administration+1
Do lasers work?
Yes, many lighten CALMs, but results vary and some spots recur after months or years. BioMed Central
Which laser is best?
Studies show several (alexandrite 755 nm, Nd:YAG 1064 nm; picosecond or nanosecond) can work. The “best” depends on skin type and lesion. Patch-test first. PubMed
Are picosecond lasers safer?
Some studies suggest similar efficacy with fewer side effects, but your results can vary. PubMed
How many sessions do I need?
Usually several sessions; your dermatologist will plan based on test response. BioMed Central
Can diet or vitamins fade these spots?
No. Diet supports overall skin health only. Medscape
Are OTC lighteners safe?
The FDA warns many OTC “skin-lightening” products are misbranded or unsafe; use prescription care only. U.S. Food and Drug Administration
What is Legius syndrome?
A genetic condition with multiple CALMs but without the tumors seen in NF1. DermNet®
Do CALMs mean I have NF1?
Not by themselves. Many people have one or a few CALMs and are healthy. Doctors look for several criteria, not just spots. NCBI
Is surgery a good idea?
Usually no. Excision can scar and often looks worse than the spot. Lasers are preferred if treatment is desired. DermNet®
What should parents do first?
Measure and count the spots, protect from sun, and ask a pediatrician if the child has many spots or other signs. Mayo Clinic

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