Treatment of persistent Mongolian spots with Q-switched alexandrite laser

Mongolian spots are congenital and confluent hyperpigmented areas that are usually grayish blue in color. They are found most frequently in the sacral region in infants and typically disappear during childhood. Occasionally, they persist to adulthood. We retrospectively examined outcomes of laser treatment of persistent Mongolian spots. We used Q-switched alexandrite laser to treat persistent Mongolian spots of 16 Japanese patients at 14 years old or older. A good therapeutic outcome was achieved overall; however, postinflammatory hyperpigmentation and hypopigmentation were observed in two patients, respectively. While laser treatment was effective for all seven patients with extrasacral Mongolian spots, four out of ten patients with sacral Mongolian spots were refractory to treatment. Of these patients, two received laser irradiation only twice and abandoned treatment, simply because of unsatisfactory results without any adverse events. The other two patients received treatments at intervals of 3 months, which resulted in postinflammatory hyperpigmentation. Contrary to children, who generally show good response after two or three sessions of irradiation, we should consider more frequent irradiation, longer intervals between treatment sessions, and use of bleaching creams in the treatment of persistent sacral Mongolian spots in adults.