Café-au-lait (CAL) spots have a distinct appearance on the skin that sets them apart from other birthmarks. Characteristics of CAL spots include:
An increase in the number of skin cells (melanocytes) that produce the protective pigment that darkens skin (melanin) in the thin outer layer of your skin (epidermis) causes café-au-lait (CAL) spots. The reason for the increase in melanocyte cells is unknown.
people diagnosed with neurofibromatosis type 1 (NF1) have CAL spots due to a mutation of the _NF1 gene. The NF1_ gene prevents cells from growing too quickly, which causes melanocytes to produce too much melanin in your skin.
Sometimes the NF1 gene mutation occurs randomly without being present in a person’s family history while others can inherit this condition from their parents if one of their parents has a mutated copy of the NF1 gene (autosomal dominant). Unlike all other autosomal dominant conditions that only need one mutated gene to activate the condition in the child, NF1 does not trigger until later during a person’s lifetime when a genetic mutation of their second copy of the NF1 gene occurs.
After your child is born, your child’s healthcare provider will physically examine your baby to make sure they’re healthy. During this exam, they will take note of any birthmarks on your child’s body, including café-au-lait spots and ask you to keep an eye on how many your child has as they grow older. Spots might not be entirely visible on your newborn, but they might become more visible after your child turns two years old or after sun exposure.
Multiple (more than six) café-au-lait spots can be a sign of an underlying genetic condition including:
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If you notice your child has more than six café-au-lait spots on their body, visit your child’s healthcare provider.
Café-au-lait spots don't need treatment since they are benign (noncancerous) and do not cause symptoms.
If you want to remove your café-au-lait spots for cosmetic reasons, talk to your healthcare provider about laser treatment. With laser treatment, there is a risk of hyperpigmentation, scarring, the spot’s pigmentation might not clear completely or they could return after being removed.
Café-au-lait (CAL) spots are present from birth and will be with your child for their entire life. The spots may change size and shape over time and could become more noticeable when exposed to the sun. If you see that your child acquires more than six CAL spots on their body, visit your child’s healthcare provider to see if the spots could be a sign of an underlying genetic condition.
You cannot reduce your risk of café-au-lait spots because there is no way to prevent birthmarks.
For people who have a history of genetic conditions like neurofibromatosis type 1 (NF1) running in their family, talk to your healthcare provider about genetic testing to understand your risk of having a child with the condition before you plan on becoming pregnant.
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Visit your healthcare provider if you notice your child’s café-au-lait (CAL) spots appear swollen, bumpy or lumpy to the touch or if they increase in size or number. It's common to have a few CAL spots, but more than six spots can be a sign of an underlying condition. Additional symptoms of common underlying conditions that cause CAL spots as symptoms include:
Yes. Café-au-lait (CAL) spots are most often present on a newborn’s skin but it is common for CAL spots to develop on a person’s skin later in life. It is normal for a person to have a few CAL spots but more than six spots may be a sign of an underlying condition. No matter what age, if you notice you have more than six CAL spots on your body, contact your healthcare provider to examine your spots for an underlying condition.
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Yes. It is very common for people to have a few café-au-lait spots on their bodies without having an underlying condition like neurofibromatosis type 1 (NF1). People diagnosed with NF1 usually have more than six café-au-lait spots on their bodies along with additional symptoms related to their diagnosis.
Although they may look like a rash, café-au-lait (CAL) spots are not the result of an allergic reaction. CAL spots differ from a rash based on their light to dark brown color (whereas rashes are pink to red in color) and they don’t create any symptoms like itchiness that you might get from a rash.
Café-au-lait spots are harmless birthmarks that appear on your child’s skin. Although they are harmless, keep count of how many spots are on your child’s skin because more than six spots could be a sign of an underlying condition. Reach out to your healthcare provider if you notice changes to your child’s birthmarks.
As your child grows, you need healthcare providers by your side to guide you through each step. Cleveland Clinic Children’s is there with care you can trust.
Last reviewed on 03/31/2022.
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