Kuala lumpur: Some parents may notice brown patches, known as café-au-lait macules, on their child's skin but pay little attention to them, assuming they are merely birthmarks. This is especially true when the child does not complain of pain, itchiness, or any discomfort. Café-au-lait is French for 'coffee with milk', referring to the patches' characteristic light to dark brown color and flat appearance on the skin. While these patches are generally harmless when they appear alone, experts caution that multiple café-au-lait macules may be associated with certain underlying conditions. According to BERNAMA News Agency, Dr. Nor Azila Mohamed Akil, a consultant dermatologist at ParkCity Medical Centre, explained that café-au-lait macules are hyperpigmented patches caused by changes in melanin production, the pigment responsible for skin color. Their shade may range from light brown to dark brown, depending on an individual's skin tone. "Usually, these patches can be present at birth or appear during early child hood. In some cases, parents only notice them as the child grows older or after exposure to sunlight, which can make the patches more visible," she told Bernama. She mentioned that having one or two café-au-lait macules is not uncommon and, in most cases, they are simply a variation in skin pigmentation that does not cause pain, itching, or other health problems. "Therefore, when parents discover such patches on their child's skin, they should not immediately assume they are a sign of disease. What is more important is to look at the overall pattern of the patches rather than the presence of a single spot," she added. However, not every brown patch on the skin is a café-au-lait macule. Several other skin conditions may appear similar, including congenital melanocytic nevus, a birthmark caused by an overgrowth of pigment-producing skin cells. Dr. Nor Azila emphasized the importance of a doctor's examination to accurately identify the type of patch, advising parents against making their own diagnosis based so lely on information found on the Internet or social media. Dr. Nor Azila further explained that the focus is not solely on the presence of these patches but also on their number, size, and whether they are accompanied by other clinical signs. "When the number of patches increases and they meet certain criteria, we will begin considering whether the condition could be associated with a genetic disorder such as neurofibromatosis type 1 (NF1). However, café-au-lait macules alone are insufficient to make a diagnosis. They must be assessed together with other clinical features," she said. NF1 is a progressive genetic disorder that can be passed down from either parent. In clinical practice, doctors pay closer attention when a child has six or more café-au-lait macules measuring more than five millimeters before puberty, or more than 15 millimeters after puberty, as this may raise suspicion of NF1. Dr. Nor Azila shared that some NF1 patients do not seek medical attention even after noticing café-au-lait macules, only coming forward after developing other symptoms linked to the condition. Apart from neurofibromas, NF1 may also be associated with other complications such as scoliosis, impaired physical growth, learning difficulties, high blood pressure, and vision problems. Dr. Nor Azila stressed that not all children with café-au-lait macules will develop these conditions and advised parents to seek medical evaluation if the patches show suspicious changes or are accompanied by other symptoms. Consultant pediatrician Dr. Faisal Mohd Fadzli from Tawakkal Specialist Hospital Kuala Lumpur emphasized the importance of monitoring these patches to assist doctors in making an accurate diagnosis. He highlighted that doctors cannot determine whether a patch is merely a birthmark or a symptom of a disease without a comprehensive examination. The assessment includes the child's development, family medical history, eye examination, bone assessment, blood pressure monitoring, and other related clinical signs. Dr. Faisal also ad dressed a common misconception that removing café-au-lait macules through laser treatment can eliminate the risk of associated diseases. "Cosmetic treatment may only reduce or alter the appearance of the patches on the skin surface, but it does not change the underlying genetic condition if it exists. Therefore, clinical evaluation and monitoring should continue according to medical advice," he stated. In conclusion, Dr. Faisal advised that children with only one or two café-au-lait macules who are growing normally and show no other symptoms generally do not require urgent medical assessment. However, parents are encouraged to inform their doctors about the patches during routine health check-ups to monitor any changes over time. "The most important thing is for parents to remain alert to changes in their child's skin or health and seek early medical advice if there are concerning signs. In most cases, café-au-lait macules are not something to worry about and that is the key message we want to convey," he sa id.