Café au lait spots, or café au lait macules, are flat, hyperpigmented birthmarks. The name café au lait is French for "coffee with milk" and refers to their light-brown color. Café au lait lesions with rough borders ("coast of Maine") may be seen in McCune-Albright syndrome. In contrast, Café au lait lesions of neurofibromatosis have smooth borders ("coast of California").They are caused by a collection of pigment-producing melanocytes in the epidermis of the skin.These spots are typically permanent and may grow or increase in number over time.Café au lait spots are often harmless but may be associated with syndromes such as neurofibromatosis type 1 and McCune–Albright syndrome. Cause
Café au lait spots can arise from diverse and unrelated causes:
Ataxia–telangiectasia
Basal cell nevus syndrome
Benign congenital skin lesion
Bloom syndrome
Chédiak–Higashi syndrome
Congenital melanocytic naevus
Fanconi anemia
Gaucher disease
Hunter syndrome
Jaffe–Campanacci syndrome
Legius syndrome
Maffucci syndrome
They can be caused by vitiligo in the rare McCune–Albright syndrome. Multiple mucosal neuroma syndrome
Having six or more café au lait spots greater than 5 mm in diameter before puberty, or greater than 15 mm in diameter after puberty, is a diagnostic feature of neurofibromatosis type I (NF-1), but other features are required to diagnose NF-1. Familial multiple cafe-au-lait spots have been observed without an NF-1 diagnosis. Noonan syndrome
Silver–Russell syndrome
Tuberous sclerosis
Watson syndrome
Wiskott–Aldrich syndrome

Diagnosis
Diagnosis is visual with measurement of spot size. The number of spots can have clinical significance for diagnosis of associated disorders such as Neurofibromatosis type I.
Nonallergic rhinitis is inflammation of the inner part of the nose that is not caused by an allergy. Nonallergic rhinitis involves symptoms including chronic sneezing or having a congested, drippy nose without an identified allergic reaction. Other common terms for nonallergic rhinitis are vasomotor rhinitis and perennial rhinitis. The prevalence of nonallergic rhinitis in otolaryngology is 40%. Allergic rhinitis is more common than nonallergic rhinitis; however, both conditions have similar presentation, manifestation and treatment. Nasal itching and paroxysmal sneezing are usually associated with nonallergic rhinitis in comparison to allergic rhinitis. Types
Rhinitis medicamentosa – rebound nasal congestion suspected to be brought on by extended use of topical decongestants and certain oral medications that constrict blood vessels in the nose. Treatment includes withdrawal of nasal drops, short courses of systemic steroid therapy and in some cases, surgical reduction of turbinates, if they have become hypertrophied. Rhinitis of pregnancy – pregnant women may develop persistent rhinitis due to hormonal changes. Nasal mucous become edematous and block the airway. Some may develop secondary infection and even sinusitis in such cases. Care should be taken while prescribing drugs. Generally, local measures such as limited use of nasal drops, topical steroids and limited surgery (cryosurgery) to turbinates are sufficient to relate the symptoms. Safety of developing fetus is not established for newer antihistamines and they should be avoided. Honeymoon rhinitis – this usually follows sexual excitement, leading to nasal stuffiness.