Treatment of café-au-lait macules with a high-fluenced 1064-nm Q-switched neodymium:yttrium aluminum garnet laser.

Café-au-lait macules (CALMs) are light to dark brown macules or patches of increased melanin concentration found along the dermoepidermal junction. Although many attempts to treat CALMs using various kinds of laser/light-based devices have been reported, CALMs remain refractory thereto with high recurrence rates. In this case series, we describe four patients with idiopathic CALMs that were effectively and safely treated with a non-ablative, high-fluenced, Q-switched (QS), 1064-nm neodymium:yttrium aluminum garnet (Nd:YAG) laser. The typical laser parameters for treating CALMs, including a spot size of 7-7.5 mm, a fluence of 2.4-2.5 J/cm2, and one to two passes until the appearance of mild erythema, but not petechiae, were utilized in this study over 12-24 treatment sessions at 2-week intervals. We suggest that high-fluenced QS 1064-nm Nd:YAG laser treatment can be used as an effective and alternative treatment modality for CALMs with minimal risk of side effects.