Therapeutic options for management of Hori's nevus: A systematic review

Abstract

Hori's nevus is a pigmentation disorder reported mainly in middle-aged Asian women.There is no systematic review addressing its pharmacotherapy. The population for our systematic review was patients with a clinical/histological diagnosis of Hori's nevus (both sex, any age group). We screened five literature databases using relevant keywords. All RCTs, observational studies and case series mentioning at least one intervention and outcome of that intervention were included. Nineteen studies were included in the final systematic review from total 680 identified nonduplicate records. Different forms of laser (alexandrite laser [QSAL and PSAL], Nd:YAG laser [QSNYL high fluence, low fluence, 532 followed by 1064 nm], Er: YAG and Nd:YAG combination, ruby laser [QSRL], CO 2 laser followed by QSRL) and dermabrasion were found to be useful in treatment of Hori' nevus. Among alexandrite lasers, PSAL is more efficacious and safe than QSAL. In case of high fluence QSNYL, hyperpigmentation rate is quite high while low fluence QSNYL requires more number of treatment sessions. The combined 1064 nm + 532 nm protocol is better in terms of efficacy and safety. Er:YAG + Nd:YAG combination have similar efficacy and added advantage of synergistic action and no adverse event. K E Y W O R D Sacquired bilateral nevus of Ota-like macules, acquired circumscribed dermal facial melanocytosis, Hori's nevus, nevus fuscoceruleus zygomaticus, management, therapy

Long-Term Follow-up for 1,064-nm Nanosecond and Picosecond Laser Treatment of Acquired Bilateral Nevus of Ota-Like Macules

“…4 Theoretically, intervals of 1 to 6 months were used in between laser sessions to allow for scavenging of pigment by macrophages. 1,3 The observed continuing clearance of ABNOM even after 6 months after the last laser treatment may be attributed to the role of resident tissue macrophages (RTMs) that have a broad spectrum of immune-and non-immune-related roles in tissue support. A local inflammatory response after laser's photomechanical effect on melanin pigment may trigger the so-called macrophage-trained immunity, resulting in a longterm effect that promotes the recruitment of monocytes that can differentiate into new RTMs, potentiating the continuation of the phagocytic process of the fragmented melanin, which may underlie the progressive fading of ABNOM lesions.…”

“…A cquired bilateral nevus of Ota-like macules (ABNOM) is a common dermal melanocytic lesion in middle-aged Asian women, characterized by blue-brown macules occurring bilaterally on the malar areas of the face. 1 Because the condition occurs prominently on the face, cosmetic disfiguration is a major factor in social interaction and almost inevitably impacts the quality of life of affected individuals.…”

“…Various pigment-selective lasers including nanosecond and picosecond lasers with a photoacoustic effect on melanin are currently the mainstay of treatment for ABNOM. 1 As with most dermal pigmentary disorders, single treatment with or without topical bleaching agents for ABNOM is generally not effective for long-term pigmentary reduction or elimination. In clinical practice, multiple, sequential treatments (up to 10–15), with treatment intervals usually based on the physician's discretion, ranging from once a week 2 to every 6 months 3 are performed for favorable aesthetic outcome or complete clearance of the pigmented lesions.…”

Symmetric facial macules in an Asian woman

“…Aggravating or triggering factors include sun exposure, hormonal medications and changes, stress, and trauma [4]. The age of onset varies widely, but it commonly develops after the age of 15, with a reported mean age of 30 [5]. Patients may also display other concurrent pigmentary dyschromias including melasma, lentigines, and/or nevus of Ota [1,3].…”

“…Pigment-specific lasers, including Q-switched ruby, alexandrite, ER:YAG and Nd:YAG lasers offer the most promising results. The selective photothermolysis caused by the laser may be the reason for its beneficial effect [5]. Cost may be a limitation and patients should be counseled on the possibility of transient postinflammatory hyperpigmentation with laser therapy [5].…”