BACKGROUND: Acquired bilateral nevus of Ota-like macules (ABNOM) is a dermal pigmented lesion common in individuals of Oriental origin. The Q-switched Nd:YAG laser (QSNYL) has been used successfully to treat a variety of benign, dermal, pigmented lesions, including nevus of Ota lesions. The similarity between ABNOM and nevus of Ota suggested that QSNYL may also be effective in the former. OBJECTIVE: To determine the efficacy and side-effect profiles of QSNYL treatment of ABNOM in Korean patients. METHODS: Of 42 Korean patients with ABNOM, 29 were treated with QSNYL (1,064 nm, 3 mm spot size, fluence 8~9.5 J/cm2), for up to 10 sessions each. Clinical photographs were taken before and after treatment. Lesion clearance was graded and complications such as hyperpigmentation, scarring, hypopigmentation, and erythema were assessed. RESULTS: Of the 29 treated patients, 19 (66%) showed excellent or good results. Of the patients who were treated more than 3 times, 76% showed good to excellent results. Two patients experienced post-laser hyperpigmentation (PLH), which persisted for more than one month, but no patient experienced persistent erythema or hypertrophic scarring. CONCLUSION: QSNYL is safe and effective in the treatment of ABNOM in Korean patients. Short-interval repetitive treatment is especially useful in improving therapeutic results and reducing PLH.
Cicatrix ; Cicatrix, Hypertrophic ; Erythema ; Humans ; Hyperpigmentation ; Hypopigmentation ; Laser Therapy ; Nevus ; Nevus of Ota

A 3-year-old boy presented with bluish patch and scattered blue spots on the left side of his face. After several sessions of laser treatment, the azury patch in the periorbital area became even darker. Histopathology showed many bipolar, pigment-laden dendritic cells scattered in the papillary and upper reticular dermis. Immunohistochemically, these cells were positive for S100, SOX-10, melan-A, P16, and HMB-45. The positive rate of Ki-67 was less than 5%. Finally, the lesion was diagnosed with nevus of Ota concurrent with common blue nevus. Therefore, for cases of the nevus of Ota with poor response to laser treatment, the possible coexisting diseases should be suspected.
Male ; Humans ; Child, Preschool ; Nevus, Blue/pathology* ; Nevus of Ota/therapy* ; Skin/pathology* ; Face ; Skin Neoplasms/pathology*

BACKGROUND: Nevus of Ota (NO) is a relatively common pigmentary disorder in Asians. Tanino's classification is an old but tacit consensus to delineate the disease. Various treatment options have been presented. However, a few studies have been conducted on available laser options and current treatment strategies or the classification of NO. OBJECTIVE: To investigate current laser options and their effectiveness for the treatment of NO, contributing factors to clinical outcomes, and verification of classification. METHODS: A retrospective study of NO was conducted by reviewing medical charts and photographs of sixty-seven patients. Statistical analysis was used to compare excellent and poor outcomes and determine contributing factors. RESULTS: The median age of onset was below the age of 1 (interquartile range [IQR], 0~1). Tanino's and PUMCH classification systems failed to classify patients in 24 (35.8%) and 6 (9.0%) of patients, respectively. A 1,064 nm Q-switched Nd:YAG laser without additional lasers was used most frequently in 42 patients (62.7%). The frequency of treatment was 19.0 (IQR, 10.0~23.0) in the cured group defined as subjects showing 95% improvement or above, compared to 10.0 (IQR, 6.25~13.75) in the unattained group defined as subjects showing less than 95% improvement (p=0.001). CONCLUSION: A 1,064 nm Q-switched Nd:YAG laser is a reliable treatment armamentarium, functioning as a single infallible modality as well as a combination treatment modality for NO. Repetitive laser treatments without interruption seems to be the most suitable in clearing NO. The current classification systems of NO are defective. Thus, a new classification should be developed.
Age of Onset ; Asian Continental Ancestry Group ; Classification* ; Consensus ; Humans ; Laser Therapy ; Nevus of Ota* ; Nevus* ; Pigmentation ; Retrospective Studies

Q-switched(QS) Lasers have been successfully used to treat nevus of Ota with a few complications. A 51 year old woman had nevus of Ota affecting the left half of her face from birth. During childhood and adolescence, her nevus enlarged and has remained stable since her late teens. She was treated with Q- switched Alexandrite Laser (fluences: 5.5J/cm2, spot size: 3mm, repetition rate: 10Hz). After 7 sessions(interval 6 weeks), complete clearance was achieved. She complained that the treated side of her face looked much younger than the other side. Alexandrite Laser therapy and post- treatment therapies might be considered to cause this problem. First, she applied 0.025% retinoid and 4% hydroquinone ointment on her treated area every night. Second, laser treatment for intradermal pigmented lesion tightened dermal collagens. In cases of middle aged women with dermal pigmented lesions (nevus of Ota), collagen tightness of dermal layer is considered to cause rejuvenation effect. In order to balance the two sides of her face, we made her apply the same post-treatment therapies on the normal side. After 18months, the effect of rejuvenation of the treated area still lasted and the normal side also improved. This case implies that skin care on the entire face pre- and post-treatment is important in a laser therapy for nevus of Ota. Especially when it comes to middle aged women, rejuvenation therapies are recommended.
Adolescent ; Collagen ; Female ; Humans ; Laser Therapy ; Lasers, Solid-State* ; Middle Aged ; Nevus of Ota* ; Nevus* ; Parturition ; Rejuvenation* ; Skin Care

The evaluation of pigmentary skin lesions by clinical doctors has been based on subjective and qualitative judgements. Observations have mostly relied on visual inspection, making the effects of treatment difficult to evaluate with any precision. For this reason there is a real need for an objective method to evaluate prognosis after treatment. Recent scientific measurements such as reflectance spectrophotometry and reflectance colorimetry have provided accurate quantitative color information about skin lesions, but these techniques are costly and difficult to apply in the clinical field. The purpose of this study was to develop a simple and cost-effective way of evaluating treatment results. We have developed a software program using the L*a*b* color coordinate system to quantify the effect of treatment and have successfully demonstrated its clinical usefulness. Our method compares the relative color difference between normal skin and skin lesions before and after treatment, instead of measuring the absolute color of skin lesions. The accuracy of our quantitative color analysis was confirmed by the simulated images of hemangioma and ota nevus. Clinical efficacy was also confirmed through a blind test involving 3 clinicians who were asked to grade the treatment effects of 13 cases of hemangioma and 7 cases of ota nevus. These subjective clinical grades correlated well with the treatment results obtained using the proposed color analysis system (Correlation coefficient = 0.84).
Color* ; Female ; Hemangioma/therapy ; Hemangioma/pathology ; Human ; Nevus of Ota/therapy ; Nevus of Ota/pathology ; Outcome Assessment (Health Care)/methods* ; Pigmentation Disorders/therapy* ; Pigmentation Disorders/pathology* ; Skin Neoplasms/therapy ; Skin Neoplasms/pathology ; Skin Pigmentation* ; Software*

BACKGROUND: Acquired bilateral nevus of Ota-like macules (ABNOM) are a common form of hyperpigmentation in Asian populations, characterized by brownish-blue or slate-gray pigmentation in the bilateral malar regions. The purpose of this study was to evaluate the efficacy and complications of a Q-switched (QS) fractional ruby laser in the treatment of ABNOM. METHODS: Forty-four patients with ABNOM treated with a QS fractional ruby laser from January 2014 to February 2016 were enrolled in this study. Patients received up to 10 treatment sessions, at intervals ranging from 3 to 4 weeks. An automatic skin diagnosis system was used before and after laser treatment to evaluate the efficacy of the laser treatment. To evaluate the complications of the laser treatment, a retrospective chart review was conducted. RESULTS: Forty-one patients were female, and 3 were male. The mean age of the patients was 47.2 years, and the mean follow-up period was 14 months. The median skin pigmentation score was 5 (interquartile range [IQR], 5–6) before laser treatment and 3 (IQR, 3–4) after laser treatment. A statistically significant difference (P < 0.01) was found in the skin pigmentation score before and after laser treatment. CONCLUSIONS: This study suggests that, although multiple sessions are required, QS ruby fractional lasers can be considered an effective and less invasive form of treatment of ABNOM.
Asian Continental Ancestry Group ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hyperpigmentation ; Laser Therapy ; Lasers, Solid-State ; Male ; Nevus of Ota ; Nevus ; Pigmentation ; Retrospective Studies ; Skin ; Skin Pigmentation

Both acquired bilateral nevus of Ota-like macules (ABNOM) and nevus of Ota are characterized by the presence of dermal melanocytes. There are no differences in the method of treatment, however, postinflammatory hyperpigmentation (PIH) develops more often in ABNOM than in nevus of Ota following treatment. We investigated the differences in the development of PIH after treatment between ABNOM and nevus of Ota, and the histopathologic differences in the PIH. A total of 82 patients with ABNOM (n=47) and nevus of Ota (n=35) were treated with Q-switched alexandrite laser and followed up 2 weeks and 3 months later. Biopsies were performed on lesional skin before treatment. The distribution and the amount of melanin pigments were visualized with Fontana-Masson stain, and the distribution and the depth of melanocytes were measured by GP-100 (NK1-beteb) stain. Clinically, there was more erythema and PIH in ABNOM than in nevus of Ota. Histopathologically, intradermal melanocytes were clustered in groups and dispersed perivascularly in ABNOM, while melanocytes were scattered evenly throughout the dermis in nevus of Ota. Both groups show that when there is a statistically significant number of melanocytes in the perivascular area, erythema and PIH occur after laser therapy. In conclusion, indirect vessel injury in addition to perivascular clustering melanocytes might be considered the cause of increased PIH after treatment in ABNOM.
Adolescent ; Adult ; Child ; Child, Preschool ; Comparative Study ; Humans ; Hyperpigmentation/*pathology ; Laser Therapy, Low-Level ; Melanocytes/*chemistry/cytology ; Middle Aged ; *Nevus of Ota/pathology/therapy ; *Nevus, Pigmented/pathology/therapy ; Silver Nitrate ; *Skin Neoplasms/pathology/therapy ; Treatment Outcome

OBJECTIVETo investigate injury to epidermal melanocyte by Q-switched Alexandrite laser.

METHODSMultiple biopsies were performed on 5 patients with nevus of Ota from before irradiation to 1 year after irradiation. Fourteen specimens were obtained for light microscopy, and 17 for transmission electron microscopy.

RESULTSMelanosomes in epidermal melanocytes were both smaller in size and fewer in number than those in dermal melanocytes. Immediately after irradiation, focal extracellular vacuoles of the basal layer could be observed under light microscopy. Most epidermal melanocytes underwent mild or moderate injury in the form of vacuolated melanosomes, swollen mitochondria, dilation of endoplasmic reticulum, and expansion of extracellular space, retaining intact cell membranes. Normal structures were restored 5 months to 1 year after irradiation, with no depigmentation or hyperpigmentation as seen by light microscopy.

CONCLUSIONInjury of melanosomes in epidermal melanocytes is reversible.

Adolescent ; Adult ; Beryllium ; therapeutic use ; Female ; Humans ; Laser Therapy ; Lasers ; adverse effects ; Melanocytes ; radiation effects ; Microscopy, Electron ; Nevus of Ota ; pathology ; radiotherapy ; ultrastructure ; Skin Neoplasms ; pathology ; radiotherapy ; ultrastructure

OBJECTIVETo evaluate the clinical response of Nevus of Ota to Q-switched Alexandrite laser, and analyze factors that influence the treatment outcome.

METHODSA total of 522 patients treated with Q-switched Alexandrite laser were included in the study. Single and multiple variate analyses of various factors were performed.

RESULTSSatisfactory result was observed in all patients, none of whom developed scarring. Clinical response was improved with additional treatment sessions. The clinical response of the 20 - 27-week treatment interval group was significantly better than that of the 12 - 19-week interval group, but showed no significant difference as compared with both the 28 - 35 and > or = 36-week interval group. Zygomatic, buccal and frontal areas showed better response than ocular and temporal areas. Treatment session, interval, and fluence were significant factors identified by multivariate analysis.

CONCLUSIONSQ-switched Alexandrite laser is an ideal method for treating Nevus of Ota without injury. The number of treatment sessions is more important than interval or fluence.

Adolescent ; Adult ; Child ; Child, Preschool ; Facial Neoplasms ; pathology ; surgery ; Female ; Humans ; Infant ; Laser Therapy ; adverse effects ; methods ; Male ; Middle Aged ; Nevus of Ota ; pathology ; surgery ; Pigmentation Disorders ; etiology ; Skin Neoplasms ; pathology ; surgery

OBJECTIVETo analyze clinical information and efficacy of 602 cases of nevus of Ota, and investigate the histopathology and ultrastructure on the melanocytes before and after Q-switched Alexandrite laser irradiation.

METHODSClinical information of 602 cases of nevus of Ota were collected by applying clinical records, checking photos, and inquiry to patients by letters and telephones. Ten cases of biopsies were observed by light microscopy and 6 cases by electron microscopy before and after laser irradiation.

RESULTSNevus of Ota included congenital and acquired cases. Skin lesions mainly occurred in adolescence for the acquired cases. The main colours of lesions were brown and blue. The most local lesions were zygomata, temporal regions, and lower eyelids. According to multiple regression, the more treatment times, the better results. The effective rate was 85.20% and 100% after 6 and 9 treatment times, respectively, while the cure rate was 55.72% and 98.46%, respectively. The eyelids involved and Tanino types influenced the treatment times by COX models analysis. Electron microscopy showed many melanosomes in the dermal melanocytes. After laser irradiation, the outlines of the dermal melanocytes were observed, the melanosomes were broken to dense and tiny granules.

CONCLUSIONSQ-switched Alexandrite laser is safe and effective for the treatment of nevus of Ota. The results of treatment are correlated with the area and size of the lesion. The dermal melanocytes in nevus of Ota can be selectively destroyed by Q-switched Alexandrite laser with less injury around tissues.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Laser Therapy ; Male ; Melanocytes ; ultrastructure ; Melanosomes ; radiation effects ; ultrastructure ; Nevus of Ota ; radiotherapy ; ultrastructure ; Skin ; ultrastructure ; Skin Neoplasms ; radiotherapy ; ultrastructure