Nevus of Ota: More Than A Simple Case Of Hyperpigmentation

Image Credit: https://dermnetnz.org/topics/naevus-of-ota-ito-hori/

Did you know that skin pigmentation is a highly variable, complex trait that only humans have? In fact, variation of skin pigmentation is a by-product of human evolution to better adjust to levels of UV radiation (UVR). Not all skin is the same – and this goes beyond your typical Fitzpatrick skin types. When it comes to Asian skin, we are more susceptible to a particular form of hyperpigmentation than most. Introducing: Nevus of Ota.

Nevus of Ota: That Grey-Blue Pigmentation

Otherwise known as oculodermal melanocytosis, Nevus of Ota is a type of dermal melanocytosis that causes hyperpigmentation of the eye and the surrounding area. Apart from appearing as brown, blue or grey patches, Nevus of Ota is typically unilateral. This means it usually involves only one side of the face.

Unfortunately, it is not known why dermal melanocytosis occurs. It’s been theorised that specific genetic mutations to the melanocytes (cells that produce pigment melanin) cause the entrapment of these specialised cells, which then develops into the archetypal grey-blue hyperpigmentation. Other hypotheses suggest that hormones or radiation exposure may have played a role in its development.

Red Flags: When Should You Worry

Since Nevus of Ota appears in areas controlled by the trigeminal nerve, this may translate to a possible disruption to the sensation on the face. Nevus of Ota that affects the eyes themselves can cause the thickening of the tissues in and around the eyes, which increases the risk of ocular complications such as intraocular pressure and glaucoma.

Whilst it’s true that Nevus of Ota is typically benign, that doesn’t necessarily mean that you should throw caution to the wind. Malignant degeneration, whilst rare, is still a possibility. 1 in 400 patients developed malignant melanoma and there is also a 10.3% risk of glaucoma.

If the area of dis-colourisation develops ulcers, or a variation in pigmentation with the development of papules (a raised area of skin), it’s important that you seek professional help. In such cases, a skin biopsy or ophthalmological screening may be required.

Bid Goodbye To Nevus of Ota

There is no way to know the cause of Nevus of Ota, thus prevention is almost impossible. However, all hope is not lost! You can still treat its symptoms in the following ways:

1. Ophthalmic

Those who have developed hyperpigmentation in the area surrounding or in the eye may have to undergo ophthalmological screening, gonioscopy and dilated fundus examination to rule out any possibilities of glaucoma, uveal melanoma or other types of eye cancer.

2. Dermatologic

For those whose hyperpigmentation is on the skin, the type of treatment is dependent on whether the area is benign or otherwise.

Treatment to rid malignant hyperpigmentation is dependent on two things: the size of the targeted area and the degree of the invasion. Mohs micrographic surgery can be employed to remove the cancerous cells whilst preserving the surrounding tissue. This advanced surgical technique offers precise microscopic control of the entire malignant margin, removing the cancerous tissue one at a time until all of it has been removed. For those with more extensive lesions, treatments will include a combination of complete surgical excision along with chemotherapy, adjuvant radiotherapy.

On the other hand, cosmetic treatments will only require the removal of the grey-blue pigment, and not the tissues themselves. As such, Q-switched and picosecond lasers are often employed to treat the targeted area. These lasers employ their selective photothermal and photoacoustic effect to destroy the melanocytes, effectively decreasing the pigmentation.

PicoWay

Delivering laser light energy in one trillionth of a second, PicoWay laser offers a ground-breaking technology that helps you rid hyperpigmented areas in a fast, effective and safe manner.

By distributing ultra-short bursts of energy directly into the skin, the laser light energy produces a ‘photoacoustic’ effect that easily breaks up the pigmentation into particles that are later discharged from the body as waste matter.

Utilising 3 different wavelengths (532nm, 785nm and 1064nm) means that dermatologists are granted with the ability to customise treatments according to your skin’s needs. The best part? The treatment offers minimal to no side effects, which mean you can continue with your daily activities almost right away!

PicoSure

Known as the world’s first and only 755nm picosecond laser, PicoSure has clinched a spot as a picosecond aesthetic laser that has made a remarkable breakthrough in the laser technology industry.

Similar to PicoWay lasers, PicoSure produces an intense photoacoustic impact that helps break down the hyperpigmentation within the tissue. Not only that, its adjustable pressure can boost Picosure Pressure Wave to levels never seen before. When the pulse widths are reduced from 750 to 550 picoseconds, the pressure is magnified by 70%. In doing so, pigments are easily shattered, effectively removing your Nevus of Ota with just a few sessions!

Final Thoughts

Early detection for any suspicious change in the skin is crucial – in most cases, such skin issues can be cured if they are diagnosed and treated early. Even though Nevus of Ota is typically benign, it’s best to seek the help of a dermatologist or ophthalmologist (depending on your pigmentation location) for risks of malignant melanoma or glaucoma.

If the case is clear and you still wish to rid the grey-blue pigment on your skin, we can help! At Angeline Yong Dermatology, we offer our bespoke and multifaceted dermatologic solutions, so you will no longer need to worry about letting spots come between you and your ideal complexion!

With an unwavering commitment to dermatology, Dr Yong has not only served more than a decade at the National Skin Centre, but has also played a crucial role in the development and progression of laser technology as a key opinion leader for Cynosure in the Asia Pacific region. Dr Yong is also the first Singaporean to meet the requirements needed to be a member of the American College of Mohs Surgery, the leading body that accredits Mohs Micrographic Surgeons in the US.

Trust your skin to Dr Angeline Yong, a dermatologist in Singapore who is equally committed to her patients and her craft. Contact our dermatologic clinic and say goodbye to Nevus of Ota for good!

References

Agarwal P. (2021). Edited by Patel B. Nervus Of Ota and Ito. https://www.statpearls.com/ArticleLibrary/viewarticle/110341.

Nam J-H, Kim H-S, Choi Y. J., Jung H. J., Kim W-S. (2017). Treatment And Classification of Nevus of Ota: A Seven-Year Review of a Single Institution’s Experience. Ann Dermatol, 29 (4), 446-453.

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Nevus of Ota: More Than A Simple Case Of Hyperpigmentation