Treatment of nevus of Ota with the Q-switched ruby laser.

BACKGROUND: Nevus of Ota is a benign bluish or gray-brown lesion of the eye and the surrounding skin that has been reported to occur in about 1 in 200 people in Japan. Prior treatments have either been ineffective or caused scarring. The Q-switched ruby laser can produce very short high-energy pulses and can selectively target cells that contain pigment, such as dermal melanocytes.

METHODS: We treated the skin lesions of 114 patients (25 male and 89 female) with nevi of Ota with a Q-switched ruby laser set to deliver pulses of 6 J per square centimeter of body-surface area at a wavelength of 694.3 nm, with a pulse duration of 30 nanoseconds. The interval between treatments ranged from three to four months. Five dermatologists who were not familiar with the patients independently compared a full set of pretreatment and post-treatment photographs of each patient and determined the percentage of pigment lightening of the affected areas using standard criteria.

RESULTS: Of the 35 patients who received four or five treatments, 33 had an excellent response (lightening of 70 percent or more), and 2 had a good response (lightening of 40 to 69 percent). Of the 31 patients who received three treatments, 4 had an excellent response, 26 a good response, and 1 a fair response (lightening of 10 to 39 percent). Of the 25 patients who received two treatments, 2 had an excellent response, 16 a good response, and 7 a fair response. Of the 23 patients who received one treatment, 3 had a good response, 13 a fair response, and 7 no response (lightening of 9 percent or less). No patient had hypertrophic or atrophic scarring; eight patients had postinflammatory hyperpigmentation for up to two months after the first treatment.

CONCLUSIONS: Selective photothermolysis with the Q-switched ruby laser is a safe and effective method for lightening nevi of Ota. Multiple treatments increase the response rate.