Approach Considerations
It is important to note that some treatment methods may result in scarring, and recurrence is a possibility.
Medical Care
Cosmetic camouflage makeup can minimize the disfiguring facial pigmentation resulting from nevus of Ota. [39] Nonsurgical methods include chemical peeling, dermabrasion, and topical hydroquinone-based bleaching products.
Surgical Care
Laser surgery is the first-line treatment. [40] Pulsed Q-switched laser surgery is the treatment of choice for nevi of Ota and Ito, and it works via selective photothermal and photomechanical destruction of dermal melanocytes and melanophages. High success rates and minimal adverse effects have been reported with the Q-switched ruby, [41] Q-switched alexandrite, [42, 43, 44] and Q-switched Nd:YAG lasers. [42, 45] After 4-8 treatments, skin pigmentation is reduced dramatically or removed in 90-100% of cases, with a less than 1% risk of scarring.
In 2016, it has been shown that similar results may be achieved using a 755-nm Q-switched picosecond laser compared with Q-switched nanosecond lasers. In a 2016 study of patients with nevus of Ota, there was no statistically significant difference in visual analog scores for six patients treated with the picosecond laser and ten patients treated with nanosecond laser. Notably, no picosecond laser‒treated patients experienced any permanent dyspigmentation, compared with 16% in the nanosecond laser group. [46]
Other surgical methods currently have been superseded by laser surgery but include the following:
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Cryotherapy [47]
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Microsurgery
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Dermabrasion (alone or combined with other modalities, such as carbon dioxide snow, autologous epithelial grafting)
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Sequential dry ice epidermal peeling
Consultations
Secondary to the increased risk of ocular melanoma in patients with nevus of Ota, it is important for patients to receive consultation with ophthalmologists with biannual follow up.
Complications
Complications of surgical treatment include a risk of scarring.
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Nevus of Ota. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/lesions/ota2.jpg).
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Nevus of Ota. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/lesions/ota.jpg).
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Nevus of Ito. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/lesions/melanocytosis-ito.jpg).
Tables
Condition |
Onset |
Appearance |
Location |
Histology |
Nevi of Ota and Ito |
Birth or early adolescence |
Blue or gray speckled coalescing macules or patches |
Nevus of Ota: Unilateral, rarely bilateral, on forehead, temple, zygomatic, or periorbital areas Nevus of Ito: Shoulder and upper arm areas |
Increased dermal melanocytes, with surrounding fibrosis and melanophages |
Mongolian spot |
Birth |
Poorly demarcated large blue-to-gray patches that tend to spontaneously resolve by age 3-6 y |
Most frequently on lumbosacral areas, buttocks, and rarely, other areas |
Increased dermal melanocytes; no surrounding fibrosis |
Blue nevus |
Congenital or acquired |
Blue papules or plaques |
Anywhere on skin |
Dermal nodular proliferation of heavily pigmented spindle cells |
Acquired nevus of Ota-like macules (Hori nevus) |
Acquired, presenting in adulthood |
Gray macules or patches |
Usually bilateral and symmetrical; over the cheeks, temples, root of the nose, alae nasi, eyelids, and forehead |
Diffuse upper-dermal melanocytosis |
Melasma |
Acquired; may be associated with pregnancy and other estrogen excess stages |
Well-to-poorly demarcated and irregularly outlined brown-to-gray brown patches |
Maxillary and zygomatic areas on face |
No increase in dermal melanocytes; presence of melanophages |
Lentigo maligna |
Acquired; presenting usually after fifth decade of life |
Brown patches, usually with pigmentary variegation |
Photodistribution, particularly within zygomaticomaxillary areas |
Atypical melanocytes in nests at dermal-epidermal junction, with pagetoid spread |
Actinic lentigo |
Acquired; usually after fifth decade of life |
Well-demarcated brown papules or plaques |
Photodistribution, especially on face |
Elongation of rete ridges; basal layer hyperpigmentation; slight increase of melanocyte number along basal layer |
Phytophotodermatitis |
Acquired; exposure to certain plants or cosmetics |
Gray-to-brown macules and patches |
Photodistribution, according to sites of contact with photosensitizer |
Dermal melanophages |
Drug-induced hyperpigmentation |
Acquired; following drug exposure (eg, minocycline, amiodarone, gold) |
Variable according to offending drugs |
Variable according to specific offending drugs |
Variable but may involve presence of dermal melanophages; pigmentation of basal keratinocytes |
Exogenous ochronosis (rare) |
Adulthood; following topical application of hydroquinone |
Irregularly shaped blue-to-gray patches or macules |
Areas corresponding to exposure to hydroquinone |
Yellow banana-shaped spindle cells in papillary dermis |
Ochronosis (alkaptonuria, rare) |
First decade of life |
Blue-gray discoloration of ear cartilage, tip of nose, and sclera |
Symmetrical distribution over cartilage, nose, cheeks, and extensor tendons of hands, as well as flexural areas |
Yellow-to-brown pigmentary granules within dermal macrophages |
