I will be tackling a difficult task of treating a comlicated case of Nevus of Ota affecting the maxillary and orbit area of the face. It is a young lady in her mid twenties who has recently developed the case of wide spread nevus of ota on her left cheek and left brow area.

Differential Diagnosis of Blue nevus VS Nevus of Ota has been confirmed.
How would you best approach this treatment?
Some colleagues are suggesting fractionated Erbium laser, Fraxel laser, or CO2 resurfacing. I am starting with a 1064 Q switched ND YAG laser to treat the pigment and surpress the melanocytes hoping to get good result without causing too much damage to the epidermis.

The risk of PIH is great in this type IV skin young lady. I have instructed her to use Sun screen SPF30 BID, and start a course of Triluma Hydroquinone 4% for 3 months. We will start treatment in Late October.

Thanks in advance for your feedback and suggestion for treating this patient.

Ken,

I tried the fractionated erbium 1550nm on a 38 y.o. hispanic male (Fitz IV). He seemed to have some initial response but after 4 treatments we felt we were getting no where. There were no signs of hyper-pigmentation related to the treatments. We stopped the fraxel treatments and I have since purchased a Hoya Con Bio Revlite Q-switched. I have done only one treatment using the 1064nm so far but I think it is going to be the best choice.

If you look at the studies, they really do not support the use of the tri-luma prior to treatment but do show some benefit after treatment has started. You probaly do not need to treat with the Tri-Luma for the 3 months. I would maybe go a few weeks.