Nevus of Ota Treatment for Improved Confidence
Nevus of Ota is very common in Asian patients. The condition is more common in females, with a male-female ratio of 1:4.8. Most patients seek treatment early in life due to the psychological trauma and cosmetic disfigurement. The Q-switched lasers have changed the way we approach the condition and have become the mainstay of therapy.
Nevus of Ota (oculodermal melanocytosis, nevus fuscoceruleus ophthalmomaxillaris) is a dermal melanocytic hamartoma that presents as bluish/slate-gray hyperpigmentation along the first or second branch of the trigeminal nerve. In 1916, Pusey described the case of a Chinese student with both scleral and facial pigmentation. It was not until 1939 that the condition was defined as an entity by Ota, from the University of Tokyo, who described bluish-gray irregular hyperpigmentation along the first and second divisions of the trigeminal nerve with frequent mucosal involvement. Since then, this melanocytic nevus has been widely known as nevus of Ota.
Nevus of Ota is the commonest in Asian patients and affects between 0.014% and 0.034% of the Asian population. The age of onset is bimodal, with larger peak at birth or soon after and a smaller peak at adolescence. Nearly all lesions appear by 30 years of age.It is usually unilateral on areas supplied by ophthalmic and maxillary divisions of trigeminal nerve, predominantly V1 and V2. This usually corresponds to forehead, temple, nose, eyelid, ear, and scalp. It may involve the sclera, with hyperpigmentation of the cornea, iris, retina, hard palate.The pigmentation varies and can be dark brown to blue to black-blue.The condition is more common in females, with a male-female ratio of 1:4.8.
Most patients seek treatment early in life due to cosmetic disfigurement and the ensuing psychological trauma. Treatment options were limited prior to the advent of laser therapy. The Q-switched lasers have changed the way we approach the condition and have become the mainstay of therapy. We aimed to study the safety and efficacy of Nd:YAG laser in Indian population.
Why Neves Of Ota
Treatment can begin at any time, including early infancy. Some of the most effective treatment options for the lesion are the Ruby, nd:YAG and PicoSure lasers. Treatments are performed with either topical anesthesia, local anesthesia and in some cases, none at all. Typically multiple treatments are required. Post treatment recovery is based upon the choice of laser. Some of the treatments result in minimal redness of the skin for days, others may lead to some crusting for a week or so following treatment. The various options are reviewed with each patient or their families at the time of consultation. In most cases, treatment can begin the day of the consultation.
• Both of these lesions present as bluish macules which are present at birth or shortly thereafter. They are believed to represent hamartomas, and are distinguished only on their site of presentation.
• The nevus of Ota (nevus fuscoceruleus ophthalmaxillaris) is present on the upper face in the distribution of the first two branches of the trigeminal nerve. The eye and/or nasal or oral mucosa may also be involved.
• The nevus of Ito (nevus fuscoceruleus acromiodeltoideus) is located in the supraclavicular, scapular or deltoid regions unilaterally.
• The nevus of Ota and the nevus of Ito show identical histologic features.
• There are scattered dendritic melanocytes within the upper dermis, more dense than in Mongolian spot, without disruption of the dermal collagen.
• The dendritic melanocytes contain fine melanin granules.
• The dendritic melanocytes may aggregate around skin appendages, blood vessels and nerves.
Treatment For Nevus of Ota
Normally The FDA approved Q-switched ruby laser is used for treatment. In most cases it is difficult to detect where the mark once was. The affected area is exposed to laser pulse and it feels like a rubber band snapping against the skin – as it is in case of any Intense Pulsed Light Treatment. Each pulse treats a small area.
It is a non-invasive treatment meaning – no cuts, no wounds, no blood, no pain, no stitches and no down time – one can resume work immediately!
Types of Laser for Nevus Of Ota
Different types of Q-switched (QS) lasers have been used successfully to treat nevus of Ota. The purpose of this study was to compare the clinical efficacy and complication of QS alexandrite (QS Alex) laser versus QS neodymium:yttrium aluminum garnet (Nd:YAG) (QS Nd:YAG) laser for bilateral nevus of Ota. Seventeen patients with bilateral nevus of Ota were treated randomly with QS Alex in one half of face and QS Nd:YAG in the other half with an interval of at least 3 months between each. Subjective assessment was made by both patients and dermatologists. Patients were also examined for evidence of complications. All patients experienced improvement (p < 0.05). There was no statistically significant difference between the two sides (p > 0.05). The pain after a short period of laser therapy was more severe for QS Alex than for QS Nd:YAG laser. Vesicles developed in 1 patient after QS Alex therapy. Both QS Alex laser and QS Nd:YAG laser were equally effective at improving bilateral nevus of Ota. Patients tolerate QS Nd:YAG laser better than QS Alex laser.