Facial pigmentation spots and patches are one of the biggest skin concerns of
Singapore women. Some pigmentations are difficult to manage while others are difficult to diagnose. However, Ota nevus and Hori’s macule are the exception and the easiest to manage. They only respond to laser treatment and almost always respond with near complete resolution.
Nevus of Ota is a birthmark typically occurring on one side of the face. Frequently, it affects the skin around the eyes, forehead, nose, and cheeks. Besides skin, it may also involve parts of the eye or mouth.
It usually appears as blue-grey hyperpigmentation because there are many pigment cells found deep within the dermis of the skin. 40-50% of all cases of nevus of Ota are present at birth, while the rest typically develop during adolescence.
Laser treatments are the most effective in treating nevus of Ota. These include QS Nd:YAG, ruby laser, and alexandrite laser and they must be repeated many times ( at least 5-6 times). Alternatively, people may opt to cover the hyperpigmentation with camouflaging creams, foundation, or concealer.
Aside from their physical appearance, one has to be aware of the risk of glaucoma and malignant melanoma.
Hori’s macule is also known as acquired nevus of Ota-like macules (ABNOM) and is a fairly common facial pigmentation that is often under-diagnosed or mis-diagnosed as freckles or melasma. Not uncommonly, it may coexist with melasma.
Often occurring on both sides of the cheek, the bean-sized pigmentation can appear from light brown, dark brown to dark blue in color. The nose, eyelids, forehead are sometimes affected as well. However, it does not affect the eyes or the mouth.
Contrary to the nevus of Ota, Hori’s nevus appears in the third to fifth decades of life and is therefore an acquired condition, mostly occurring in Asian women.
Hori’s nevus only responds to laser treatments with the Q-switched ruby laser, Q-switched alexandrite laser or Q-switched Nd:YAG lasers. Multiple sessions (at least 4 to 6 ) are usually necessary.
Temporary darkening of the skin (post inflammatory hyperpigmentation) may occur after the first treatment. However, this usually settles from second treatment onwards and the improvement and lightening continues steadily with each session of laser treatment til it fades eventually.
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