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OBJECTIVE Nevus of Ota represents congenital dermal melanocytosis in a trigeminal distribution, most commonly occurring in Asian individuals and other individuals with skin of color. Evidence suggests early treatment is beneficial. Multiple reports have shown efficacy and safety of Q-switched laser treatment in adults. There is little data on children and in non-Asian skin types. This series was done to demonstrate safe and effective use of Q-switched laser therapy in children of multiple skin types. STUDY DESIGN Retrospective case series. METHODS This was a chart review of patients under 18 years old who presented to our practice from 2002 to 2015 with a clinical diagnosis of nevus of Ota who were treated with Q-switched lasers (694 and 1,064 nm). Patients were treated without the use of general anesthesia or sedation, and corneal shields were used in appropriate cases. Percentage of improvement as well as side effects were rated by five physicians independently. Improvement, when present, was rated in quartiles (1-25%, 26-50%, 51-75%, and 76-100% improvement). RESULTS Twenty-four children were included. The average age at the start of treatment was 3.9 years old (range of 3 months to 12.4 years), and patients had Fitzpatrick skin types IV through VI. The mean number of treatments was 9.3. Assessment revealed excellent response (76-100% improvement) in 70% of patients and good to excellent response (51-100% improvement) in 86%. Two patients (8%) had post-inflammatory hyperpigmentation, one of whom also had focal hypopigmentation. CONCLUSION Treatment of nevus of Ota with Q-switched lasers in children with skin of color, without general anesthesia or sedation, is safe and effective. Early intervention should be encouraged for better efficacy and to prevent psychosocial distress in later childhood and adulthood. Lasers Surg. Med. 50:56-60, 2018. © 2017 Wiley Periodicals, Inc.

Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.

A 5-year-old, female, spayed Rhodesian Ridgeback presented with ocular melanocytosis and skin hyperpigmentation involving the distribution of the first and second divisions of the trigeminal nerve on the right side of the face. The dermatomal pattern of the hyperpigmentation was similar to nevus of Ota or oculodermal melanocytosis reported in humans. This condition has been associated with increased risk of developing secondary glaucoma and melanoma transformation in skin, ocular, orbital tissues, and the central nervous system. The clinical investigation and description of oculodermal melanocytosis (nevus of Ota) are presented for the first time in the dog.

Acquired, bilateral nevus of Ota-like macules (ABNOM) is one of the most common dermal melanocytoses. Although there are some literatures on ABNOM, its clinical features and etiopathogenetic factors have not been fully understood.To determine the prevalence and characteristics of ABNOM among the Chinese patients.A survey was carried out using the clinical examination and a questionnaire on 3212 first-time outpatients in our dermatology department, and 102 cases of ABNOM were subsequently enrolled.The outpatient prevalence of ABNOM was 3.18%, and the age of the onset was 27.2 years on average. They all presented as speckled macules on the face alone or coexisted with patchy lesions (17.7%) or a band-like pigmentation (1.0%). Unprecedentedly, we found the zygomatic arch, the infraorbital, the cheek and the parotid region can be involved, and 52.0% cases had sclera pigmentation. ABNOM commonly coexisted with the pigmented fungiform papillae of the tongue, the melasma, the acne, prementstrual syndrome (female) and breast cystic hyperplasia (female) with the rates of 33.3%, 20.6%, 26.5%, 47.0% and 43.0% separately. Triggering factors' investigation disclosed screen irradiation (47.1%), pregnancy (32.0%), cosmetics (29.4%), sensitive skin (22.6%), and positive family histories (21.6%) were highly related.Our study confirms that ABNOM is a relatively common disorder among adult Chinese's outpatients. It is commonly distributed over the malar, lateral forehead and temple's areas. The sclera pigmentation is another common finding that is overlooked in previous research. ABNOM is concomitant with melasma and some other disorders. Excessive sun exposure, hormonal disturbances and hereditary susceptibility are the main potential triggering factors of ABNOM.

Melanocytic lesions of the CNS are rare tumours originating from melanocytes that are present in the leptomeninges. They consist of a spectrum of pigmented tumours ranging from melanocytoma to melanoma. A small group of these tumours have histopathological features between those of a benign melanocytoma and a malignant melanoma; these present as intermediate grade melanocytic neoplasms. Naevus of Ota is a blue hyperpigmented dermal lesion characterized by increased number of melanocytes in the distribution of ophthalmic and maxillary divisions of the trigeminal nerve. The association of an intracranial intermediate-grade melanocytic neoplasm with a nevus of Ota is extremely rare, with only 2 cases reported in the literature to date. As a result, their behavior and progression are still poorly understood. We present the first case of a familial naevus of Ota associated with intermediate-grade melanocytic neoplasm.

Background Heightened intraocular pressure resulting in glaucoma and impaired vision is treatable if detected early. It is therefore necessary to identify populations at risk for glaucoma for regular screening visits. Objective To investigate the prevalence of glaucoma in patients with facial port-wine stains (PWSs), nevus of Ota, and phakomatosis pigmentovascularis (PPV) and to establish the association between facial vascular birthmarks and ocular complications. Methods This study is a retrospective chart review of 166 patients with facial PWS, PPV, and nevus of Ota over a 10-year period. Results Of the 166 cases, 76 patients were diagnosed with PWS, 83 with nevus of Ota, and 7 with PPV. The mean age of patients was 12.8 years, ranging from newborn to 63 years old. Fifteen patients were diagnosed with glaucoma. Of 15 patients, 11 presented with PWS, and 4 presented with both PWS and PPV. Of 83 patients with nevus of Ota, only 2 (2.4%) presented with increased ocular pressure. Limitations The relatively short follow-up period is a limiting factor in this study. Conclusions Early and periodic ophthalmic examinations in patients with PWS, PPV, and nevus of Ota are essential to minimizing the risk of developing glaucoma in these groups of patients.

Nevus of Ota (NO) also known as nevus fuscoceruleus ophthalmomaxillaris or oculodermal melanocytosis is a rare hamartoma. It is usually characterized by unilateral, patchy and speckled, blue/gray or brown macules on the forehead and periocular area. Here, we report a rare case of NO with oro-buccal involvement, which is an unusual condition. The patient was presented due to the rarity of oro-buccal involvement, extensive and remarkable expression of the lesions, and in order to propose a more comprehensive and neuroanatomy based classification system.

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], CO2 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.

Dermal melanocytosis is characterized by bluish gray color of lesion, location which develop due to entrapment of migratory dendritic melanocytes in dermis during fetal development. Four clinically distinct entities are nevus of Ota, nevus of Ito, Mongolian spots, and nevus of hori. We are describing a case of 22 year old male with single hyperpigmented macule on left cheek with scleral involvement. Histopathology showed presence of elongated dendritic melanocytes in dermis. Diagnosis of nevus of Ota was made. Nevus of Ota also known as oculodermal melanocytosis because it typically involves distribution areas of ophthalmic and maxillary division of trigeminal nerve. Clinically it is characterized by unilateral speckled bluish gray colored macule with or without ocular and oral mucosa involvement. The lesion tends to persist and increase in size locally, becoming increasingly prominent with age. Diagnosis is usually clinical but sometimes biopsy may be required to rule out close differentials including nevus spilus, melasma, blue nevus and cafe-au-lait macule. Important associated disorders include ipsilateral glaucoma; intracranial melanocytosis; and rarely cutaneous, ocular, or intracranial melanoma. Treatment with multiple sessions of pulsed Q-switch lasers (ruby, alexandrite, nd:yag) are first choice and have shown almost complete clearance.

Nevus of Ota or "oculodermal melanocytosis" is a rare congenital hamartoma of dermal melanocytes causing a blue-gray hyperpigmentation of the eye and surrounding structures. The condition, originally described by Ota and Tanino in 1939, mainly affects the ophthalmic and maxillary divisions of the trigeminal nerve. We describe the first reported case of unilateral oculodermal melanocytosis in a Caucasian woman with oral buccal mucosal involvement. Oral involvement of nevus of Ota is very rare.A 48-year-old Caucasian woman was referred by the dermatology division to the oral medicine department at the University of Liverpool School of Dentistry with new-onset oral pigmentation to the left buccal mucosa. The patient had a previous diagnosis of oculodermal nevus.An incisional biopsy of the left buccal mucosa was completed. The report stated that histological and immunohistochemical features were in keeping with a blue nevus, but within the context of the preexisting occulodermal pigmentation, a diagnosis of oculodermal melanocytosis, also known as "nevus of Ota," was made. The patient will be kept under review in the oral medicine department because the progression of the lesion on the left buccal mucosa requires active monitoring owing to the potential for malignant change. The patient also requires regular review in the dermatology and ophthalmology divisions.

Background In clinical settings, atypical facial hyperpigmentation such as nevus of Ota, acquired bilateral nevus of Ota-like macules (ABNOM), melasma, and cafe-au-lait spots are often missed and misdiagnosed. Summarizing in vivo reflectance confocal microscopy (RCM) features of the hyperpigmentation is helpful in the diagnosis of ambiguous lesions. Methods We recruited 196 patients referred for unequivocal facial hyperpigmentation, including 55 patients with nevus of Ota, 45 patients with ABNOM, 62 patients with melasma, and 34 patients with cafe-au-lait spots. The RCM images were evaluated at the epidermis, the dermis-epidermis junction (DEJ), and the upper papillary dermis from both hyperpigmented patches and normal skin. Results In the superficial and middle dermis, 41 of 55 patients (74.5%) with nevus of Ota were characterized by a cord-like or lumpy structure between the collagen fibers. And there was no melanin deposition detected in the dermis in 14 of 55 (25.5%) patients. In ABNOM, 37 of 45 (82.2%) patients were characterized by a cord-like or lumpy structure in the superficial dermis and 8 of 45 patients (17.8%) was no melanin deposition detected in the dermis. The epidermis was no difference between nevus of Ota, ABNOM, and the normal skin. Melasma was detected increased cobblestone pattern in the epidermis of all patients, branching architecture in 21 of 62 patients (33.9%), and focally aggregated round to triangular cells in the upper dermis of 18 of 62 patients (29.0%). In all patients with afe-au-lait spots, increased cobblestone pattern in the epidermis and regular and increased density of ringed pattern in the DEJ were visualized. Conclusions Our findings indicate that RCM may be useful in the auxiliary diagnosis of nevus of Ota, ABNOM, melasma, and cafe-au-lait spots.

Non-tumorous facial pigmentation, though not fatal, adversely affects one's quality of life and may indicate concurrence of systemic diseases. Automatic diagnosis method such as voting-based probabilistic discriminant analysis (V-PLDA) has been explored, but the accuracy of classification is not satisfactory due to the limited number of data for training. This paper proposes to use the pre-trained deep learning network of Inception-ResNet-v2 so that information from similar datasets can be utilized. Furthermore, data augmentation using synthetic minority over-sampling technique (SMOTE) is also applied to make full use of available training data. A clinical dataset of five most common types of non-tumorous facial pigmentation disorders in Asia, namely freckles, lentigines, melasma, Hori's nevus, and nevus of Ota, is used for training and testing. The classification accuracy has shown significant improvement (> 7%) compared to the state-of-the-art method.

IntroductionNaevus of Ota is a congenital condition that may involve the skin, eyeball and even intracranial structures usually in the distribution of the ophthalmic and maxillary divisions of the trigeminal cranial nerve. The purpose of this study was to summarise our experience with the ocular clinical presentation, imaging, outcome, treatment of complications and to offer a new classification of patients with naevus of Ota.MethodsWe retrospectively reviewed the patients’ medical records and the following parameters were retrieved and analysed: demographics, clinical presentation complications and treatment of complications. Imaging characteristics of patients with naevus of Ota were compared with images from the same period of time of 57 age-matched and gender-matched patients without naevus of Ota (control group).ResultsThe series was composed of 40 patients (18 males, 22 females) whose mean age at diagnosis was 35.27 years (range 0.5–77 years). Thirty-three patients (82.5%) were type I naevus of Ota according to the Tanino classification, three patients (7.5%) were type II, one patient (2.5%) was type III and three patient (7.5%) were type IV (bilateral naevus of Ota). We further classified all cases in according to the ocular involvement extent. Three patients developed malignant transformation to choroidal melanoma and four patients developed glaucoma.ConclusionsIn this study, a new clinical classification based on the involved ocular component and extent of the involvement (in quadrants) of the globe is suggested first. Further studies are needed to assess whether our clinical ocular classification can assist in identifying patients at risk for developing glaucoma and malignant transformation.

Background and aims Recently, novel picosecond pulse duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that ps-lasers could be an alternative treatment for dermal pigmented lesions. We performed a retrospective review to evaluate the efficacy and safety of the ps-laser for nevus of Ota. Subjects and methods A retrospective photographic review of 15 patients with nevus of Ota was performed (ages from 10 months to 65 yr). The patients were treated in the Ohshiro Clinic with a picosecond-domain 755 nm alexandrite laser (ps-Alex laser) from June 2015 to August 2017. Improvement was evaluated as the percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a four category grading scale: Poor, 0-24%; Fair, 25-49%; Good, 50-74%; and Excellent 75-100% improvement. Adverse events were also assessed. Results All patients obtained clinical improvement ranging from fair to excellent. All 5 patients whose primary treatment was the ps-Alex laser obtained excellent in 2-3 treatment sessions (average 2.5 sessions), and the average total treatment span was 10.0 months. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months of follow-up. Conclusions Our results suggest that 755 nm ps laser treatment is efficacious for the treatment of nevus of Ota with minimum adverse events.

Background Cerebellopontine angle represents a complex anatomical area of the brain. A cerebellopontine angle lesion could be a vestibular schwannoma, meningioma, epidermoid cyst, or less likely, arachnoid cyst, metastasis, lower cranial nerves schwannoma, lipoma, hemangioma, paraganglioma, or vertebra-basilar dolichoectasia. Primary meningeal melanocytoma is a rare neoplasm, especially when it occurs at the cerebellopontine angle. Nevus of Ota (aka oculodermal melanocytosis) is a hyperpigmentation along the distribution of the ophthalmic and maxillary branches of trigeminal nerve; it occurs due to entrapment of melanocytes at the upper third of the dermis. It may not present at birth and may show up at puberty. Case description We describe a case of primary meningeal melanocytoma of the cerebellopontine angle associated with nevus of Ota in a 46-year-old male patient presented with 7-day history of left arm weakness and vertigo. Computed tomography and MRI showed right-sided cerebellopontine angle mass, which was resected. Histopathology confirmed the meningeal melanocytic lesion and revealed its nature. Conclusion Primary meningeal melanocytoma of the brain is a rare but benign tumor; the association between meningeal melanocytoma and nevus of Ota is also rare and possibly explained by their common embryonic origin from neural crest cells. There are six cases reported so far in literature including our case for meningeal melanocytoma associated with nevus of Ota.

Melanoma presents molecular alterations based on its anatomical location and exposure to environmental factors. Due to its intrinsic genetic heterogeneity, a simple snapshot of a tumor's genetic alterations does not reflect the tumor clonal complexity or specific gene-gene cooperation. Here, we studied the genetic alterations and clonal evolution of a unique patient with a Nevus of Ota that developed into a recurring uveal-like dermal melanoma. The Nevus of Ota and ulterior lesions contained GNAQ mutations were c-KIT positive, and tumors showed an increased RAS pathway activity during progression. Whole-exome sequencing of these lesions revealed the acquisition of BAP1 and TP53 mutations during tumor evolution, thereby unmasking clonal heterogeneity and allowing the identification of cooperating genes within the same tumor. Our results highlight the importance of studying tumor genetic evolution to identify cooperating mechanisms and delineate effective therapies.

Background and Objectives Laser procedures in skin of color (SOC) patients are challenging due to the increased risk of dyspigmentation and scarring. A novel 755 nm alexandrite picosecond laser has demonstrated effectiveness for tattoo removal and treatment of acne scars. No studies to date have evaluated its applications in pigmentary disorders. The purpose of this retrospective study was to evaluate the safety profile and efficacy of the picosecond alexandrite laser compared to the current standard treatment, Q-switched ruby and neodynium (Nd):YAG nanosecond lasers, for pigmentary disorders in SOC patients. Study Design/Materials and Methods A retrospective photographic and chart evaluation of seventy 755 nm alexandrite picosecond, ninety-two Q-switched frequency doubled 532 nm and 1,064 nm Nd:YAG nanosecond, and forty-seven Q-switched 694 nm ruby nanosecond laser treatments, in forty-two subjects of Fitzpatrick skin types III–VI was conducted in a single laser specialty center. The picosecond laser was a research prototype device. Treatment efficacy was assessed by two blinded physician evaluators, using a visual analog scale for percentage of pigmentary clearance in standard photographs. Subject assessment of efficacy, satisfaction, and adverse events was performed using a questionnaire survey. Results The most common pigmentary disorder treated was Nevus of Ota (38.1%), followed by solar lentigines (23.8%). Other pigmentary disorders included post-inflammatory hyperpigmentation, congenital nevus, cafe au lait macule, dermal melanocytosis, Nevus of Ito, and Becker's nevus. Clinical efficacy of the Q-switched nanosecond lasers and picosecond laser treatments were comparable for lesions treated on the face with a mean visual analog score of 2.57 and 2.44, respectively, corresponding to approximately 50% pigmentary clearance. Subject questionnaires were completed in 58.8% of the picosecond subjects and 52.0% of the Q-switched subjects. Eighty four percent of subjects receiving Q-switched nanosecond laser treatments and 50% of the subjects receiving alexandrite 755 nm picosecond laser treatments felt satisfied to completely satisfied. Side effects observed in subjects treated with the alexandrite 755 nm picosecond laser were similar to those commonly observed and reported with the nanosecond Q-switched technology. All side effects were temporary, resolving within one month, and no long-term complications were noted. All patients who were very satisfied with their picosecond laser treatment for Nevus of Ota noted a delayed improvement only after 3 months. Conclusion The 755 nm alexandrite picosecond, 694 nm ruby, 532 nm, and 1064 nm neodynium:YAG nanosecond lasers appear to be safe and effective modalities for removal of pigmentary disorders in skin of color patients with no long-term complications if used appropriately. This study demonstrates the potential of the 755 nm alexandrite picosecond laser in further clinical applications beyond tattoo removal. While the Q-switched lasers were effective, promising results were also observed using an early version of the novel picosecond laser for the removal of pigmentary lesions in SOC patients. As we continue to improve our understanding of the 755 nm picosecond laser, this device may prove to be a safe and effective alternative to the Q-switched lasers for the treatment of facial pigmented lesions in patients with skin of color. Lasers Surg. Med. 48:181–187, 2016. © 2016 Wiley Periodicals, Inc.

Laser treatment has emerged as a common treatment modality for acquired bilateral nevus of Ota-like macules (ABNOM). To identify the ratio of melasma induction and exacerbation before and after laser therapy for ABNOM and to observe the risk factors related to the induction and exacerbation of melasma by laser therapy, we analyzed related factors of 1268 adult Chinese patients who underwent 1064-nm Q-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser (QNYL) treatment using case series and case-control studies. Overall, 24.0% of the ABNOM patients had mixed melasma. Among the ABNOM patients without melasma, after laser therapy the development of melasma was more frequently noted in patients older than 35 years (P < 0.0001), as well in patients whose ABNOM was less than 10 cm(2) (P = 0.027), ABNOM were light (similar to yellow-brown) in color (P = 0.021) and skin types were closer to type IV (P < 0.0001). New melasma lesions also appeared most frequently in the zygomatic region (P < 0.0001). Among the ABNOM patients with melasma, 89.5% experienced worsening of their melasma, irrespective of their related factors above. We concluded that the risk of inducing melasma is great after 1064-nm QNYL treatment in ABNOM patients, and particularly in the patients with both ABNOM and melasma. ABNOM patients should be treated as early as possible and before the age of 35 years.

Background and aims: Recently novel picosecond duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that the ps-laser could be an alternative treatment for dermal pigmented lesions and performed a retrospective review to evaluate the efficacy and safety of the ps-laser. Subjects and methods: A retrospective photographic review of 10 patients with dermal pigmented lesions was performed (ages from 4 months to 52 yr), 6 nevus of Ota, 3 ectopic Mongolian spots and 1 Mongolian spots. The patients were treated in the Ohshiro Clinic with picosecond 755 nm alexandrite laser (ps-Alex laser) and picosecond 1064 nm Nd:YAG laser (ps-Nd:YAG laser) from April 2014 to December 2015 (ps-Alex laser, 7 patients; ps-Nd:YAG laser, 3 patients, 1 to 3 treatment sessions). Improvement was evaluated as percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a five category grading scale: Poor, 0-24%; Fair, 25-49%; Good, 50-74%; Excellent, 75-94%; and Complete, 95-100% improvement. Adverse events were also assessed. Results: All ten patients obtained clinical improvement ranging from fair to excellent. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months follow-up. The ps-Nd:YAG laser caused severe transient erythema and swelling but no post-inflammatory hyperpigmentation. Conclusions: Our results suggest that the 755 nm and 1064 nm ps-lasers are efficacious for the treatment of dermal pigment lesions, with minimum adverse events.

Background and objectives Photo-aging in Chinese often presents with benign pigmentary lesions. Q-switched lasers for pigmentary lesions in Asians had reported a risk of post-inflammatory hyperpigmentation (PIH) up to 25%. Longer pulse widths in the millisecond domains were advocated with reduced risk of PIH. Recently, picosecond lasers of various wavelengths were introduced with proven efficacy in tattoo removal. The objective of this study is to assess the efficacy and safety of a novel picosecond 755-nm alexandrite laser for the treatment of benign pigmented lesions in Asians retrospectively. Methods A list of all patients who received picosecond 755-nm alexandrite laser treatment at a private dermatology center in Hong Kong was included. Those who had any other laser or topical treatment during the period of picosecond laser treatment were excluded. The age, skin phototype, type of pigmentary lesion, number of treatments performed was recorded. The baseline and most recent standardized photographs were assessed by trained physicians for comparison. A score of 0–4, representing poor 0–24%, fair 25–49%, good 50–74%, excellent 75–95%, and complete 95%+ improvement was given. Adverse events associated with the laser treatment were also recorded. All patients were followed up until 6 months after the last laser session. Results A total of 13 subjects were included in the present study. The number of treatment sessions received ranged from one to seven. The benign pigmentary lesions consist of Nevus of Ota, cafe-au-lait patches, lentigines, Becker's nevus, Hori's macules, and nevus spilus. Among patients with Nevus of Ota, one patient achieved complete clearance after four treatments and two other patients had excellent clearance after three and four sessions, respectively. Patients with cafe-au-lait had fair to good clearance after one to seven treatment sessions. One patient who has Hori's macules was resistant to laser treatments and a fair response was achieved after eight treatments. In the present series, two patients (4.8%) developed transient hypopigmentation, which had improved upon subsequent follow-up in both cases and none had post-inflammatory hyperpigmentation. Conclusions The novel picosecond 755-nm alexandrine laser is effective for the treatment of benign pigmentary lesions in Chinese, especially for the clearance of Nevus of Ota. Picosecond laser appears to be associated with a much lower risk of PIH for treatment of pigmentary lesions in Asians. Lasers Surg. Med. 48:23–29, 2016. © 2015 Wiley Periodicals, Inc.

Resume Introduction Le naevus de Ota est une pathologie rare, observee plus frequemment chez des personnes d’ascendance asiatique. Il se presente cliniquement comme une hyperpigmentation maculeuse gris-bleu unilaterale du visage. La transformation en melanome et le glaucome sont les principaux risques. L’apparition de lesions de vitiligo avec poliose au sein d’un naevus de Ota est exceptionnelle. Observation Une femme de 22 ans, aux antecedents de naevus de Ota, consultait pour une depigmentation des cils. L’examen physique trouvait une hyperpigmentation en nappe orbitofrontale droite, des macules achromiques ainsi qu’une poliose des cils. Le diagnostic de vililigo developpe sur naevus de Ota etait retenu. L’examen ophtalmologique trouvait une hyperpigmentation de la sclerotique. Un suivi regulier en dermatologie et en ophtalmologie etait institue. Discussion Le vitiligo est une affection caracterisee par le developpement de lesions depigmentees secondaires a une disparition melanocytaire chronique dans l’epiderme et le follicule pileux. Sa survenue sur des naevus congenitaux et sur des melanomes a deja ete rapportee, mais son apparition au sein d’une melanocytose dermique est tres rare. Depuis la premiere observation de cette association en 1979, seuls 4 autres cas ont ete rapportes. Les mecanismes pathogeniques de cette association sont encore mal elucides. L’examen histopathologique montre en general une perte des melanocytes epidermiques, alors que les melanocytes dermiques ne sont pas affectes. Le vitiligo developpe sur melanocytose dermique resulterait ainsi de differences entre les melanocytes normaux (epidermiques) et ectopiques (dermiques). Conclusion L’association vitiligo/naevus de Ota est exceptionnelle. Nous en rapportons un nouveau cas sur peau foncee.

An elderly white man with a history of left oculodermal melanocytosis presented with new onset brown pigmentation of the left bulbar and inferior tarsal conjunctiva. The bulbar conjunctival pigmentation was at the level of the conjunctival epithelium and was overlying areas of typical slate-grey scleral pigmentation characteristic of oculodermal melanocytosis. Both areas of new pigmentation were biopsied. The bulbar conjunctiva revealed primary acquired melanosis (PAM) without atypia with increased melanin production and the tarsal conjunctival biopsy showed PAM without atypia sine pigmentio overlying areas of substantia propria spindle-shaped heavily pigmented melanocytes of oculodermal melanocytosis. The case report examines the relationship between the epithelial and substantia propria melanocytes and correlates the findings with what is known about this association from the dermatopathology literature.

Context: Facial melanoses decreases the quality of life (QoL). Melasma is the commonest cause but there are various other etiologies for facial pigmentation. Aims: To study the clinical profile of patients with facial melanoses and the psychological burden in these patients. Settings and Design: All patients having patchy or diffuse facial pigmentation attending the OPD in a tertiary care hospital for a period of 1 year were included in this hospital based cross-sectional study. Subjects and Methods: The type, extent, and distribution of the pigmentation was noted and tabulated in all patients. All patients were explained about Skindex-16 questionnaire and asked to complete it. Statistical Analysis Used: Student t-test (two tailed, independent) was used to find the significance of study parameters on continuous scale between two groups. Chi-square/Fisher Exact test was used to find the significance of study parameters on categorical scale between two or more groups. Correlation was performed using Spearman correlation. Results: The total number of cases studied was 238 of which 186 (78.2%) were females and 52 (21.8%) were males. The most common diagnosis was melasma seen in 73% of cases. Other conditions noted were phototanning (5.8%), post-inflammatory hyperpigmentation (5.8%), Lichen planus pigmentosus (4.2%), freckles (3.7%), and Nevus of Ota (1.6%). Skindex-16 score against different grades of pigmentation showed that the mean Skindex-16 score was higher in severe cases but there was no statistically significant difference between the groups. Conclusions: The extent and severity of facial pigmentation and the decrease in the QoL are not proportional.

Background Primary melanocytic neoplasms (PMNs) are rare neoplasms, especially within the central nervous system. Meningeal melanocytomas, a subtype of PMN, are even rarer. Nevus of Ota results from the incomplete migration of melanocytes from the neural crest. Synchronous nevus of Ota and meningeal melanocytoma are infrequently encountered in clinical practice. Objective To evaluate and elucidate 12 cases of synchronous meningeal melanocytoma and nevus of Ota, thereby improving the understanding of the relationship between these 2 diseases. Methods We reviewed cases and searched the English-language literature from the PubMed database and collected clinical parameters of 12 cases of synchronously occurring nevus of Ota and meningeal melanocytoma. Results Among the 12 cases, 90.90% and 91.66% of the lesions were located ipsilaterally and supratentorially, respectively. Conclusions Our findings indicated a trend for both types of lesion to be located ipsilaterally and supratentorially. When a patient with nevus of Ota is found to harbor an intracranial neoplasm, the most likely diagnosis is PMN.

Nevus of Ota is a blue, hyperpigmented, benign dermatosis of the skin and mucosae that most often occurs unilaterally in the distribution of the ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve. Although uncommon, association with malignant melanoma is a complication that must be considered in the evaluation of patients with nevus of Ota. Mutations in the

Phakomatosis pigmentovascularis (PPV) is an uncommon dermatosis characterised by the presence of both pigmentary and vascular abnormalities.(1) Its pathogenesis is not elucidated, and the prognosis is mainly determined by the presence of extracutaneous manifestations, such as Klippel-Trenaunay syndrome (KTS), that is defined by the triad of a port-wine stain (PWS), anomalous veins and progressive overgrowth of the affected extremity. Herein, we report a case of an adult patient, who presented with a large PWS, nevus of Ota, ocular melanosis, and limb hypertrophy and varicosities. These findings represented a rare association of PPV type IIb and KTS.

There is a known association between nevus of Ota and melanomas involving the brain parenchyma and/or the meninges. We present the unusual case of a 32-year-old African-American female with a nevus of Ota and a contralateral parenchymal, primary CNS melanoma. We discuss the unique features of this case and provide a brief review of the literature regarding nevi of Ota and associated CNS melanoma. Our patient is a 32 year-old, African-American female with a left-sided nevus of Ota who presented with a three month history of headaches and paresthesias involving her left face and arm. An MRI of the brain revealed a hemorrhagic mass in the right temporal lobe, which, after craniotomy, was determined to be a melanoma. Extensive imaging, ophthamologic examination and full-body skin examination revealed no other foci of melanoma. To our knowlege, this is the only case of a nevus of Ota associated with contralateral parenchymal melanoma in an African-American patient. The association of contralateral parenchymal primary CNS melanoma with nevus of Ota is extremely unusual. Futhermore, despite the association of nevus of Ota with CNS melanoma, the literature does not support routine screening of patients with nevus of Ota for CNS melanoma with imaging modalities.

Nevus of Ota can be treated successfully using the Q-switched (QS) laser; but few studies are long-term retrospective of the efficacy and influencing factor, studies on the recurrence is even less.Retrospective analysis of the clinical characteristics and recurrence of QS Nd:YAG laser treatment of nevus of Ota in 224 Chinese patients at Laser Cosmetology Center of Department of Dermatology, the Second Hospital, Xi'an Jiaotong University.The data of 224 patients with nevus of Ota were analyzed retrospectively, which included the correlation among lesion color, treatment sessions, gender, age, lesion types and effect, and all patients were followed up for 2-10 years.Higher number of treatment sessions that were conducted using the QS Nd:YAG laser system was positively associated with better responses to treatment. 99.11% of patients acquired more than 75% improvement with an average of 3.7 sessions. Only eight patients (3.57%) who had been completely cleared developed recurrence at the same site as before.The treatment of nevus of Ota with QS Nd:YAG laser is safe and effective with rare recurrence.

Nevus of Ota is a benign hamartoma which presenting as blue-gray hyperpigmented patches on the face and mucous membranes usually within the distribution of first and second branches of the trigeminal nerve. It may occur at birth or during adolescence and the nevus of Ota is very common seen in Japan and east countries. The pigmentation varies and can be dark brown to blue to black-blue. We report a 31-year-old female patient with the nevus of Ota. The Q-switched Nd:YAG laser, had a spot size of 3 mm, an 8 Hz repetition rate, 720 mj/cm2 fluence. The patient's lesion improved in a rate of 60% with a single session. The Q-switched Nd:YAG laser has a significant effect in treating the nevus of Ota.

Laser therapy can treat disorders of both hyper- and hypopigmentation, including vitiligo, lentigines, and melasma. When choosing the appropriate laser for treatment, wavelength, spot size, pulse duration, and fluence must be carefully considered. We will discuss several different lasers: the xenon chloride excimer laser (EL), the fractional carbon dioxide laser (FCO2), the quality-switched ruby laser (QSRL), the Q-switched alexandrite laser (QSAL), and the Q-switched neodymium yttrium-aluminum-garnet laser (QS Nd:YAG). Additionally, we will review and summarize the results of combination trials involving laser therapy for pigmentary disorders. While nevi of Ota and lentigines respond well to laser therapy, post-inflammatory hyperpigmentation and melasma are often resistant to therapy, and combination regimens with topical therapies may be the most effective. The utilization of lasers in medicine and dermatology will continue to evolve with improvements in laser technology.

Skin disorders are often multifactorial in nature, as both intrinsic factors such as genetics and extrinsic factors such as differing cultural practices can be implicated in disease pathogenesis. For this reason, there are a number of diseases that affect individuals with skin of color at a higher rate compared to Caucasians, and there are a number of diseases that affect males and females within these populations disproportionately. In this chapter, we discuss specific diseases that are more common in different genders and ethnicities, specifically follicular and scarring disorders and disorders of pigmentation. The follicular and scarring disorders include central centrifugal cicatricial alopecia, traction alopecia, acne keloidalis nuchae, pseudofolliculitis barbae and dissecting cellulitis. The disorders of pigmentation include nevus of Ota and melasma. Beyond exploring the clinical features, histology and treatment of these disorders, this chapter also highlights the epidemiology and pathogenesis of these diseases in an effort to explain why they may be more common in a certain ethnic group or gender.

The Nevus of Ota (NO) is a bluish or greyish hyperpigmentation caused by an accumulation of dermal melanocytes that typically extend to the innervated parts of the ophthalmic and maxillary divisions of the trigeminal nerve, involving the facial skin, the uvea, the iris and the sclera (Figure 1). This article is protected by copyright. All rights reserved.

Background Phacomatosis pigmentovascularis (PPV) has previously almost exclusively been reported in Asians and in dermatological journals. In this report, we present a case of a young black South African adolescent boy referred to our eye clinic. Case report A 15-year-old male patient presented with gradual, painless loss of vision in his right eye. Clinical examination revealed a port-wine stain with ocular involvement on the right as well as a nevus of Ota. Fundoscopy on the right revealed an advanced glaucomatous optic disc and raised intraocular pressure. A diagnosis of glaucoma associated with PPV was made. Conclusion We present the first case of PPV in an African male individual with associated glaucoma seen at our tertiary hospital.