Low-fluence 730-nm picosecond titanium sapphire laser for pediatric facial café-au-lait macules: a non-crusting treatment approach

Traditional laser treatments for café-au-lait macules (CALMs) carry risks of crusting and dyspigmentation. The 730‑nm wavelength offers high melanin absorption, potentially enabling lower energy use with enhanced photoacoustic effects. This study introduces a novel large‑spot, low-fluence 730-nm picosecond titanium sapphire laser protocol designed to be minimally disruptive, distinguished by its non-crusting endpoint and monthly treatment interval. This observational case series enrolled twenty patients with facial CALMs who received monthly treatments between 2023 and 2025 using a 730‑nm picosecond titanium sapphire laser (spot size 4 mm, fluence 1.0 J/cm², 10 Hz, 3–5 passes per session). The treatment endpoint was immediate minimal erythema without whitening or petechiae. Outcomes were assessed by physician Visual Analog Scale and parental satisfaction VAS, with monitoring for adverse effects and recurrence. Patients underwent a mean of 10.15 ± 4.17 sessions. Seven patients (35%) achieved a physician VAS score of 9, with a median VAS of 8 (IQR, 4.0, 9.0). No recurrence was observed during the limited available follow‑up period (median 7.0 months; IQR, 4.5, 10.0). Notably, no patient experienced crusting, blistering, persistent edema, or post‑inflammatory dyspigmentation; only mild transient erythema occurred, which resolved within 24 h. This is the first evaluation of a monthly, large‑spot, low-fluence 730‑nm picosecond laser for CALMs. This case series suggests that the monthly, large-spot, low-fluence 730 nm picosecond laser protocol is a promising option for pediatric facial CALMs. While the exact mechanism remains to be elucidated, the protocol demonstrated effective clearance with an excellent safety profile in this preliminary cohort. However, given the lack of objective colorimetric measurements and a split-lesion control, these findings warrant larger, rigorously designed studies. Trial registration: Chinese Clinical Trial Registry Id: ChiCTR1900027866 (Registration date: November 30, 2019).