Role of q-switched nd:yag laser in nevus of ota: a study of 25 cases.

BACKGROUND: Nevus of Ota is common condition in Indian patients. The condition is more common in females, with a male-female ratio of 1:4.8. AIM: To evaluate long-term efficacy safety and stability of Q-switched ND:YAG laser in treatment of Nevus of Ota.
DESIGN: 6 month follow-up of patients of Nevus of Ota, treated with Q-switched ND:YAG laser
MATERIALS AND METHODS: Twenty-five patients of Nevus of Ota were treated with Q-switched ND:YAG laser for a period of 1 year and 9 months; patient had fitzpatricks skin type 4 and 5; detailed history, clinical examination, ophthalmoscopy, and otoscopy was done in all cases; clinical photographs were taken before and after the completion of treatments. Six-month follow-up was done after the last session. Response to treatment was graded based on physician's global assessment. RESULT: More than 70% improvement was seen in 15 patients (60%). Eight patients (32%) had moderate and two patients (8%) showed mild improvement.

Introduction

Nevus of Ota, also known as nevus fuscoceruleus ophthalmo-maxillaris,[1] was first described by Ota in 1939.[2] It is characterized by blue-black or gray-brown dermal melanocytic pigmentation and typically occurs in areas innervated by the first and second branches of the trigeminal nerve. Mucosal pigmentation may occur involving the conjunctiva, sclera, and tympanic membrane. The condition is usually congenital. In 1988, Nevus of Ota was subclassified as mild, moderate, intensive, and bilateral. Bilateral Ota nevus should be differentiated from Hori nevus, which is acquired and does not have mucosal involvement. Malignant melanoma may rarely develop in these lesions. The treatment of this condition remains a challenge for the dermatologists.

Materials and Methods

Twenty-five patients of Nevus of Ota were treated with Q-switched ND:YAG laser for a period of 1 year (average 8 sessions) and 9 months. Of the 25 patients, five were males and the rest were females. One patient had a bilateral involvement. Patients had skin types 4 and 5. The results were documented and clinical photographs were taken before [Figure 1, Figure 3] and after [Figure 2, Figure 4] completion of treatments. Six-month follow-up was done after the last session. Response to treatment was graded based on physician's global assessment.

Figure 1

Pre-treatment

Figure 3

Pre-treatment

Figure 2

Post-treatment

Figure 4

Post-treatment

Results

Twenty-five patients of Nevus of Ota were treated with Q-switched ND: YAG laser for a period of 1 year (average 8 sessions). Of the 25 patients, five were males and the rest were females. One patient had a bilateral involvement. Patients had skin types 4 and 5. The results were documented and clinical photographs were taken before and after the completion of treatments. Six-month follow-up was done after the last session. Response to treatment was graded based on physician's global assessment.

Discussion

Hulkey first described oculodermal melanosis in 1861 and in 1916, Pusey was the first to draw attention to the relationship of a pigmented lesion of facial skin to the pigmentation of ipsilateral sclera in a Chinese student. In 1939, Ota and Tanino described several cases of pigmented nevus of the skin and eye and named them “nevus fuscoceruleus ophthalmomaxillaris of Ota.” Melanocytes move from the neural crest to the skin during early embryonic life. Failure of complete migration into the epidermis before birth with ensuing dermal nesting and melanin production produces characteristic blue patches. Dermal melanin produces blue colour because of the Tyndall effect in which all but the blue end of the light spectrum penetrates into the deep dermis and is absorbed by dermal melanin. Sex hormones have been implicated in the pathogenesis of the Nevus of Ota.[3]

In our study of 25 patients, five were males and the rest were females. One patient had a bilateral involvement. Patients had skin types 4 and 5. The results were documented and clinical photographs were taken before and after the completion of treatments. Six-month follow-up was done after the last session.

In a study by Teekhasaenee et al.,[4] 59.3% had ocular and dermal involvement, while 35% had dermal involvement. Of the nine cases with ocular involvement, all had episcleral involvement, while three (33.3%) each had involvement of the palpebral conjunctiva and the retina. Teekhasaenee et al.[4] reported 100% episcleral involvement, 10% conjunctival involvement, and 18% retinal involvement. Glaucoma was observed in a case of bilateral Nevus of Ota. Foulks and Shields[5] and Khawly et al.[6] have reported this association.

Conclusions

Twenty-five patients of Nevus of Ota were treated with Q-switched ND:YAG laser for a period of 1 year and 9 months (average 8 sessions). Of the 25 patients, five were males and the rest were females. One patient had a bilateral involvement. Patients had skin types 4 and 5. The results were documented and clinical photographs were taken before and after the completion of treatments. Six-month follow-up was done after the last session. Response to treatment was graded based on physician's global assessment.