Hypertrichosis Is Not so Prevalent in Becker's Nevus: Analysis of 47 Cases

Becker's Nevus on Face Misdiagnosed as Whiskers

Becker's nevus (BN) is a kind of epidermal cutaneous hamartoma. A noticeable hyperpigmented patch with a big, unilateral, hyperpigmented macule and irregularly shaped borders is the manner in which BN often presents. In this case, a 16-year-old boy has asymptomatic dark brown colored follicular macule on the left side of the cheek shortly after birth. The lesions were initially inconspicuous but gradually became darker as time passed. The macules on some of them grew hair. This case of BN with apparent hypertrichosis on one side of the cheek, which made it challenging to make a differential diagnosis with whiskers. The primary point of differentiation is that the lesions of BN only appear unilaterally. On the other hand, the face has whiskers on both sides. Additionally, BN will show hyperpigmentation whereas whiskers do not. In conclusion, for its unusual clinical presentation, we believe that reporting this case may help dermatologists avoid misdiagnosing similar cases.

A Retrospective Analysis of the Efficacy and Safety of Q-Switched and Picosecond Lasers for Treating Becker’s Nevus

Background. Becker’s nevus (BN) severely affects a patient’s appearance and can lead to depression, especially when it involves the face or neck. Currently, there is no effective treatment. Laser therapy has become popular, but its efficacy has not been confirmed. We evaluated the efficacy and safety of lasers in treating BN. Methods. This retrospective study involved 49 patients exposed to different laser treatments who completed at least one treatment session and follow-up. Results. The patients treated with the 755-nm alexandrite picosecond laser and Q-switched 694-nm ruby laser gained relatively good results: 3.07 ± 1.09 and 2.87 ± 1.14 on the five-point scale and 3.47 ± 0.73 and 3.40 ± 0.85 on the GAIS, respectively. However, the results of the 755-nm alexandrite picosecond laser with a diffractive focus lens array and the fractionated 1064-nm neodymium-doped: yttrium aluminum garnet picosecond laser were poor. Furthermore, there were marked differences between the number of treatment sessions and treatment effects, both for the five-point grading score for pigment clearance (F = 15.246, $p<0.001$ ) and GAIS (F = 15.469, $p<0.001$ ). Concerning different lasers and efficacy, there were no marked differences between the five-point grading scale and the GAIS ( $p>0.05$ ). Conclusions. Although the efficacy of various lasers for BN is not satisfactory and there are no marked differences between picosecond and Q-switched lasers, they can help in selecting an appropriate laser for slight-to -moderate pigment removal. The 755-nm alexandrite picosecond laser is a new option, whereas nonablative fractional picosecond lasers for BN are not recommended. Increasing the number of treatment sessions can improve the curative effect slightly.

A case of multiple, bilateral Becker's Nevi of the trunk and lower extremities in a young girl: A case report

A Becker's nevus typically appears as a single unilateral, well-demarcated, hyperpigmented patch over the upper trunk during adolescence. It uncommonly presents as multiple and bilateral patches and rarely involves a lower extremity. We describe the unusual case of a child with multiple, bilateral Becker's nevi of the trunk and lower extremities present since birth.

Laser treatment of benign melanocytic lesion: a review

Treatment of pigmented lesions is one of the major challenges of laser and cosmetic practitioners. The most common pigmented lesions that are treated by lasers are melanocytic nevi, ephelides, solar lentigines, and café au lait macules. Melanin absorbs different wavelengths (500-1100 nm); thereby, treatment of various pigmented lesions requires the application of lasers with different wavelengths. Choosing the most appropriate type of laser depends on various factors such as the chromophore and the location of a specific lesion in the skin. In this paper, we aim to review the most efficient laser treatment protocols for each pigmented skin lesion and compare their efficacy in each part based on the previous studies.

Evaluating the Roles of Different Types of Laser Therapy in Becker’s Nevus Treatment

Becker’s nevus (BN) is a cutaneous hamartoma of benign nature that develops through adolescence and affects mostly young men. The nevus is usually located unilaterally and is characterized by hypertrichosis and hyperpigmentation. Despite recent advances in treatment modalities, no effective treatment has been established for BN hyperpigmentation. We sought to assess the efficacy and safety of fractional Erbium: YAG 2940 nm and Q-switched Nd: YAG 1064 nm lasers in the treatment of BN hyperpigmentation. Twenty-three patients with BN were included in a prospective, randomized-controlled, observer-blinded, split-lesion comparative technique trial. In each patient, two similar square test regions were randomized to either be treated with a fractional Erbium: YAG 2940 nm laser or with a Q-switched Nd: YAG 1064 nm laser. Each patient was treated with three sessions at six-week intervals. At the follow-up, clearance of hyperpigmentation was assessed by physician global assessment, visual analogue scale, grade of improvement, patient global assessment, and patient satisfaction. Regions treated with the fractional Erbium: YAG 2940 nm laser demonstrated significantly better improvement compared to ones treated with the Q-switched Nd: YAG 1064 nm (p-value = 0.001) laser. Adverse effects such as repigmentation and hypertrophic scarring were not reported during the follow-up period. The outcomes were cosmetically acceptable with overall high satisfaction among the included patients. Our data suggest a superior role for the fractional Erbium: YAG (2940 nm) laser in the treatment of BN hyperpigmentation compared to the Q-switched Nd: YAG (1064 nm) laser, along with being a safer method and having no reported side effects.

An update on Becker's nevus: pathogenesis and treatment

Becker's nevus (BN) manifests as a hyperpigmented, sometimes hypertrichotic plaque/patch over the chest and shoulder, and it is in the category of benign cutaneous hamartomas. BN has elongation and fusion of the rete ridge, keratotic plugging, sebaceous hyperplasia, smooth muscle hyperplasia, and hyperpigmentation of the basal/suprabasal layer histologically. This article highlights all issues involved in pathogenesis and treatment options of BN. According to current research, postzygotic ACTB mutations induce BN and Becker's nevus syndrome (BNS). Although several therapy strategies were utilized to treat the pigmentary and hypertrichotic aspects of BN, no definitive standard treatment was identified to far, and further research is needed to better educate BN care. This article is protected by copyright. All rights reserved.

Successful treatment of Becker's nevus with dermabrasion by sandpaper: A case report

Lasers have been widely used for treatment of Becker nevus. Here, we report a case of Becker nevus which did not respond to laser therapy and was treated successfully by dermabrasion with sandpaper with no following complications.

The efficacy of intense pulsed light for Becker's nevus: A retrospective analysis of 45 cases

BACKGROUND

Becker's nevus is a common skin disorder. Lasers and light instruments are the major modalities for the treatment of Becker's nevus, but the outcomes were mixed.

OBJECTIVE

To evaluate the efficacy of the intense pulsed light for Becker's nevus in a large Chinese cohort.

METHODS

We retrospectively analyzed the efficacy of the intense pulsed light for Becker's nevus in a single center.

RESULTS

A total of 45 patients, including 26 males and 19 females (male to female ratio = 1.4), aged 5-42 years, were included in this analysis. Twenty-seven patients (60%) were with hypertrichosis. Treatments with intense pulsed light resulted in over 75% improvements in pigmentation and hair density in 1 and 2 cases, respectively. One patient displayed 51%-75% reductions in hair density. The rest displayed ≤50% improvements in pigmentation and hair density. Recurrence occurred in all cases within 6 months after the last treatment. Adverse reactions were temporary and mild hypopigmentation, hyperpigmentation, hypertrophic scar, pain, and erythema.

CONCLUSION

Intense pulsed light does not exhibit long-term benefits for Becker's nevus. Further studies in the large cohort are still required to validate the present results. Moreover, whether changes in the treatment parameters can improve the efficacy of intense pulsed light remains to be explored.

Intense pulsed light treatment for Becker's nevus

BACKGROUND

Becker's Nevus (BN) is a benign hamartoma with an esthetically troublesome condition secondary to hyperpigmentation and hypertrichosis. Many treatment modalities have been utilized with variable outcomes.

OBJECTIVES

To evaluate the efficacy and safety of intense pulsed light (IPL) in the treatment of BN.

PATIENTS AND METHODS

IPL was used at filter of 590 nm, fluence of 18-22 J/cm², double-pulse mode (pulse width of 3-10 ms, pulse delay of 20-30 ms) at 3-month intervals. Final evaluations were performed by physician global assessment and patient satisfaction. Side effects were monitored at each treatment session and follow-up visit.

RESULTS

Twenty-four patients (9 females, 15 males) with BN (16 hypertrichotic, 8 atrichotic) completed the study. The mean number of treatment sessions was 5 ± 2.17. The improvement in atrichotic BN group (4.87 ± 0.35) was significantly greater than that observed in hypertrichotic BN group (3.63 ± 0.89) (p = .001). Hair density simultaneously decreased with treatment in hypertrichotic BN. The mean satisfaction score was 5.75 ± 2.05 and 8 ± 0.93 in hypertrichotic and atrichotic BN groups respectively (p = .002). No repigmentation was noted during the follow-up period. No permanent side effects were observed.

CONCLUSIONS

IPL is an effective and well-tolerated treatment option for patients with hypertrichotic and atrichotic BN.

Lasers for Becker's nevus

Becker's nevus is a common pigmented dermatosis, usually featured by ipsilateral pigmented patch with hypertrichosis. Becker's nevus is often treated with various types of lasers although other regimens are available. However, clinical outcomes appear inconsistent among studies. To summarize the clinical outcomes of Becker's nevus treated with lasers via literature review. A variety of lasers had been used alone or in combination to treat Becker's nevus. Laser wavelengths used for Becker's nevus ranged from 504 to 10,600 nm, while the number of treatment varied from 1 to 12 sessions. The clinical outcomes were mixed although combination of lasers with different wavelengths appeared to achieve a better efficacy. Adverse effects were usually mild to moderate erythema. While lasers are relatively safe, their efficacy for Becker's nevus is moderate. It seems that combination therapy could improve the outcome. However, trials in larger group of patients are required to validate the efficacy of each type of lasers for Becker's nevus.

Clinicopathological Features and Immunohistochemical Alterations of Keratinocyte Proliferation, Melanocyte Density, Smooth Muscle Hyperplasia and Nerve Fiber Distribution in Becker's Nevus

Background

Although Becker's nevus (BN) is a relatively common disease, the systematic studies of clinicopathological and immunohistochemical results are poorly reported.

Objective

To investigate the clinicopathological features and immunohistochemical alterations of keratinocyte proliferation, melanocyte density, smooth muscle hyperplasia and nerve fiber distribution in BN.

Methods

Clinical and pathological data were collected in 60 newly-diagnosed BN cases. Immunohistochemical stain of Ki-67, Melan-A, keratin 15, smooth muscle actin and protein gene product 9.5 was performed in 21 cases.

Results

The median diagnostic and onset age was 17 and 12 years, respectively. Skin lesions usually appeared on the upper trunk and upper limbs. The pathological features included the rete ridge elongation and fusion and basal hyperpigmentation. Epidermal Ki-67, Melan-A and keratin 15 expression and dermal nerve fiber length were significantly higher in lesional and perilesional skin than in normal skin (p<0.05~0.01), while smooth muscle actin expression was upregulated only in skin lesion (p<0.05).

Conclusion

Although the clinical diagnosis of BN is often straightforward, histopathology is helpful to differentiate from other pigmentary disorders. The hyperproliferation of keratinocytes, melanocytes, arrector pili muscle and dermal nerve fibers could be involved in the pathogenesis of BN.

Sebaceus and Becker's Nevus: Overview of Their Presentation, Pathogenesis, Associations, and Treatment

Nevus sebaceus (NS) and Becker's nevus (BN) are two variants of epidermal nevi. NS clinically presents as a yellowish-orange, hairless plaque on the scalp, face, or neck, while BN presents as a tan-to-brown hyperpigmented, sometimes hypertrichotic, plaque typically on the chest and shoulder. Histologically, NS displays mature or nearly mature sebaceus glands as well as acanthosis and fibroplasia of the papillary dermis. BN shows variable papillomatosis, acanthosis, and hyperkeratosis, with hyperpigmentation of the basal/suprabasal layer. While the genetic basis of NS is thought to be due to post-zygotic mutations in the Harvey rat sarcoma viral oncogene homolog (HRAS)/Kristen rat sarcoma viral oncogene homolog (KRAS) genes, the genetic basis of BN is relatively unknown and is implicated with paradominant inheritance. In some patients, NS and BN can each be associated with additional cutaneous and extra-cutaneous anomalies, ranging from benign or malignant tumors to multiple organ irregularities. Due to the wide range of possible associations, treatment for NS and BN is devised on a case-by-case basis. In this article, we review the features, etiology, and diagnosis/management of NS and BN, with a focus on associations. We also report a patient who concomitantly presents with both lesions.