Q: Dr. Eppley, I have a birthmark that I tried to get removed. It was treated with a laser with no results. It is brown-colored and is a patch over the left side of my stomach. I have had it since I was born and it has grown in size as I have grown. I have attached a picture of it for you to see. What type of treatment should I get to remove it. Also, if it can’t be removed can it be tattooed over?
A: What you have is a classic cafe-au-lait birthmark that is virtually impossible to remove. The reason is that the brown pigment goes all the way through the skin, so no ‘pigment reduction’ laser/treatment will work. The brown color also will no respond to being lightened like age spots do with pulsed light therapies. One option may be fractional laser… test patch an area to see the response.What type of laser treatment was done before? I doubt if it was fractional. Its an option but there are no good treatments for cafe-au-lait spot removal…short of excising it and trading that off for a scar…which I am not sure is a good trade-off. Also, you can not tattoo over it and match the surrounding skin. Besides an impossibility to match the surrounding normal skin pigmentation, it is not practical to make a darker skin color lighter by tattooing.
Dr. Barry Eppley