Treating birthmarks

Birthmarks such as portwine stains, café au lait macules, Becker’s naevi and epidermal naevi are very common and can be seen in 10–20% of the normal population. In rare cases they can serve as a marker of an underlying genetic disorder.
The classification of birthmarks is extremely complex, as also any substance of skin may be exaggerated at a molecular and genetic level to cause birth marks. These include blood vessels ,vascular birth marks, soft tissue -collagen and elastin naevi, as well as Becker’s birth marks, brown pigment- CALM or café au lait macules, congenital naevi, dermal melanocytosis, naevus of Ota, and Ito, or even zits, blackheads, pimples, and acne- know as sebaceous naevus, or acniform naevus. There are another 30 more types of birthmarks that can be classified.
In this short write up I will be discussing CALM or one type of birthmark and what type of lasers I use to address it. I will do other videos on acne birthmarks within later in 2016- so will reserve that one for the popoholics, cyst extractions and blackhead removals for a topic on sebaceous naevi birthmarks.
What causes birthmarks such as CALM?
There is an increase in pigment content within the CALM spots. The cause is not known except when associated with genetic conditions such as neurofibromatosis. A single CALM can be found in 10 to 20 percent of children and up to 1 percent of children have ≥3 CALM. CALMs are one of the most common birthmarks.

How are CAFÉ-AU-LAIT macules treated?
CALM have never been reported to undergo cancerous change. Creams will have no effect. For cosmetic reasons, CALM have been treated with pigment-specific lasers such as the Q-switched ruby, Q-switched alexandrite, and Q-switched Nd:YAG lasers. However, multiple treatment sessions are usually required, responses are variable and recurrences are common. I initially tried using the Picosure at 532, but no success as the power is not high enough for this laser- the Picoway would be better. I used the old trusted Revlite nanosecond laser for this- and it worked a treat. Most patients require 2-4 sessions, spaced 6-10 weeks apart.
Fractional laser resurfacing using fractional lasers such as Fraxel, fractional co2, Fractora, Pixel, Plasma Portrait etc… can give a mild improvement however recurrence is frequently seen. Picosecond or nanosecond lasers are the treatment of choice for CALMs.
Surgical excision can also be performed in cosmetically acceptable cases- not recommend as scarring can be seen.

Thanks for watching- will be making more videos on treating other types of birthmarks including portwine stains, epidermal naevi, blackhead- acne- cyst-sebaceous naevi, and many others in the next few months. Thanks for watching, and remember to subscribe!
Dr Davin Lim
Laser and aesthetic dermatologist
BRISBANE, Australia.
Lasers and Lifts
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