| BackgroundCafe-au-lait macules are common epidermal pigmentary disorders that manifest as light to dark brown, evenly pigmented smooth patches with variable sizes and contours. Patients always seek treatment because of cosmetic concern when cafe-au-lait macules are distributed on the exposed areas. However, laser treatments of cafe-au-lait macules have shown controversial results in the literature. Most of the previous observations are based on small study population and relatively short follow-up period. Moreover, factors that might influence treatment outcome still need to be better clarified.ObjectiveTo assess the efficacy and safety of Q-switched alexandrite and ruby lasers for the treatment of cafe-au-lait macules, and to investigate potential factors that might influence the treatment outcome.MethodsA total of 80 patients with cafe-au-lait macules who initially presented to Dermatologic Laser Center of our hospital from October 2006 to May 2011 were included in the study. Patients were treated using QSAL, QSRL alone, or a combination of both lasers, and their final treatment sessions were at least 6 months prior to our follow up. Basic information, such as laser parameters, number of treatment sessions, efficacy, recurrence, complications, patient age, family history, age of onset, course of disease, as well as the number, size, location of the lesions were collected through medical records and telephone follow ups, contour of the lesions was described from the pictures. Responses were graded as poor, good, excellent and complete clearing according to the perception of fading. Long-term efficacy of laser treatment on cafe-au-lait macules are evaluated, and potential factors that might affect the treatment outcome are analyzed using Mann-Whitney U test and Kruskal-Wallis test. SPSS22.0 software was used for data processing.ResultsThe male to female ratio of the 80 studied patients was 1:1.05. All patients completed 1-8 treatment sessions, with an average follow-up time of 27.9 ± 11.6 months (6-53 months). The overall response rate was 61%, and effective rate was 42.5%. And the recurrence rate was 12.2%. Most recurrences developed 1-3 years after the final treatment, and all of them were partial recurrences. The treatment outcome was not significantly different among Q-switched alexandrite laser, Q-switched ruby laser and a combination of both lasers. Some of the cafe-au-lait macules remained laser resistant even with increased treatment sessions, indicating that the relationship between therapeutic outcome and number of treatment sessions was not simple positive correlation. We did not find any significant correlation between the efficacy and factors including gender, age of onset, course of disease and location of the lesion. Generally, smaller sized cafe-au-lait macules attained better response than larger sized lesions. And cafe-au-lait macules with jagged borders showed more clearing than those with smooth borders. Three patients (3.75%) developed long-term complications after treatment, which include hypopigmentation, skin texture changes and secondary dermatitis.Conclusions1.Q-switched alexandrite laser and ruby laser are relatively safe and effective for the treatment of cafe-au-lait macules. The long-term recurrence rate is about 12%, most of which are partial recurrences.2.The treatment outcome shows significant variation among different individuals, thus we suggest a "therapeutic endpoint" should be defined.3.The therapeutic outcome is correlated with the size and contour of the lesions, but the mechanism remains unclear.4.The long-term complication rate of QSAL and QSRL for the treatment of cafe-au-lait macules is quite low. |
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