From the Guidelines
Becker's nevus treatment should prioritize non-invasive cosmetic approaches, such as laser therapy, due to the benign nature of the condition and the potential risks associated with surgical interventions. The most effective treatment options include laser therapy, with Q-switched ruby laser and erbium:YAG laser showing good results for reducing pigmentation, while long-pulsed Nd:YAG or alexandrite lasers can help with excessive hair growth in the affected area 1. Multiple sessions are usually needed, spaced 4-6 weeks apart. Some key points to consider when treating Becker's nevus include:
- Topical treatments like hydroquinone (2-4%), tretinoin (0.025-0.1%), or azelaic acid (15-20%) may provide modest improvement in pigmentation when applied daily for several months.
- Cosmetic camouflage using makeup designed for covering skin discolorations can effectively conceal the nevus.
- Complete resolution is difficult to achieve, and recurrence after treatment is common because Becker's nevus results from a developmental anomaly affecting melanocytes and androgen receptors in the skin.
- Treatment should be individualized based on the specific characteristics of the nevus, patient preferences, and expectations, considering the potential psychosocial impact of the condition 1. It's essential to weigh the benefits and risks of each treatment option, considering the potential for scarring, dyspigmentation, and other complications associated with more invasive approaches, such as surgery 1.
From the Research
Treatment Options for Becker's Nevus
The following treatment options are available for Becker's nevus:
- Combination 1550 nm non-ablative fractional resurfacing and laser hair removal, which has been shown to be safe and efficacious in reducing hyperpigmentation and hypertrichosis associated with Becker's nevus, including in patients with Fitzpatrick skin types V and VI 2
- Intense pulsed light (IPL) treatment, which has been found to be effective and well-tolerated in treating Becker's nevus, with significant improvement in hyperpigmentation and hypertrichosis 3
- Long-pulse alexandrite laser treatment, which has been shown to be effective in treating Becker's nevus, with decreased hair density and no repigmentation during follow-up 4
- Low-fluence laser hair removal, which has been found to be safe and effective in managing hypertrichosis in Becker's nevus 5
- Erbium: YAG and Q-switched neodymium: YAG laser treatments, which have been compared in a study, with Er:YAG laser showing complete clearance in 54% of patients and > 50% clearance in 100% of subjects after 2 years 6
Laser Treatment Parameters
The following laser treatment parameters have been used in the treatment of Becker's nevus:
- 1550 nm non-ablative fractional resurfacing and laser hair removal with long-pulsed neodymium-doped yttrium aluminum garnet or alexandrite 2
- Intense pulsed light (IPL) with a filter of 590 nm, fluence of 18-22 J/cm2, and double-pulse mode 3
- Long-pulse alexandrite laser with a wavelength of 755 nm, pulse duration of 3 ms, and fluence of 20 to 25 J/cm2 4
- Low-fluence high-repetition-rate diode lasers (808-810 nm) for hair removal 5
- Erbium: YAG and Q-switched neodymium: YAG laser treatments with varying parameters 6
Efficacy and Safety
The efficacy and safety of these treatment options have been evaluated in various studies, with the following results:
- Combination 1550 nm non-ablative fractional resurfacing and laser hair removal showed a mean improvement score of 51%-75% with no long-term adverse events 2
- IPL treatment showed significant improvement in hyperpigmentation and hypertrichosis, with no permanent side effects 3
- Long-pulse alexandrite laser treatment showed excellent or good responses in 7 out of 11 patients, with no repigmentation during follow-up 4
- Low-fluence laser hair removal showed significant hair reduction at 6 and 12 months, with no adverse events reported 5
- Erbium: YAG and Q-switched neodymium: YAG laser treatments showed varying degrees of clearance, with Er:YAG laser showing superior results 6