Introduction

Café-au-lait macules (CALMs) are common benign hyperpigmented lesions with aesthetic and psychological impact, yet optimal laser treatment remains undefined.

Aim

This study evaluated the clinical efficacy and safety of combining a Q-switched alexandrite 755-nm laser with an Nd:YAG 1064-nm laser for the treatment of CALMs.

Material and methods

In total, 124 patients with CALMs were randomised into a control group (Q-switched alexandrite 755-nm laser) or a combined-treatment group (combined Q-switched alexandrite 755-nm and Nd:YAG 1064-nm lasers) (62 cases/group). Clinical efficacy was evaluated 3 months post-treatment. Subjective improvement was examined with the visual analogue scale (VAS), while objective pigmentation changes were estimated with the melanin index (MI) and digital dermoscopic image analysis. Treatment-related adverse events were recorded. Recurrence-free survival at 6 months was processed with the Kaplan–Meier method combined with the log-rank test.

Results

At 3 months following treatment, the combined-treatment group presented a higher total effective rate versus the control group (93.55% vs. 77.42%, p = 0.011). The combined-treatment group demonstrated consistently higher VAS scores across follow-up visits (p < 0.05). Both groups showed a reduction in MI, with a greater decrease observed in the combined-treatment group (p < 0.05). Dermoscopic parameters also indicated more pronounced lesion improvement in the combined-treatment group (p < 0.05). At 6 months, the combined-treatment group exhibited a lower cumulative recurrence rate (6.45% vs. 19.35%), with better recurrence-free survival (p = 0.026).

Conclusions

Combined treatment with Q-switched alexandrite 755-nm and Nd:YAG 1064-nm lasers presents superior clinical efficacy, enhanced pigmentation clearance, and lower recurrence rates compared with 755-nm laser monotherapy, without increasing treatment-related adverse reactions.