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44-Year-Old Female with Increased Pigmentation

Can you diagnose this case?

David L. Kaplan, MDSeries Editor

Signs and Symptoms

This 44-year-old woman presented for evaluation of and treatment options for increased pigmentation that had been present since age 13 on the right side of her face. There was no history of trauma or exposure and no family history of similar hyperpigmentation.

What’s your diagnosis

Choose one to reveal diagnosis and discussion

Nevus of Ito
Nevus of Ota
Nevus depigmentosus
Melasma
Chloasma

ANSWER: Nevus of Ota

See the full case at Consultant360

Nevus of Ota is a hamartoma of dermal melanocytes that is congenital and can present at birth or during puberty, as in this patient’s case. The lesions can be unilateral or bilateral and typically affect the area around the ophthalmic and maxillary branches of the trigeminal nerve.

Nevus of Ito is a similar condition, except that it affects the shoulder area. Melasma typically occurs in women after age 20 into the 40s, although men also can be affected in rare cases. Melasma is thought to be a result of genetic causes, hormonal factors, and sunlight exposure. Chloasma is synonymous with melasma; melasma is the more accurate and preferred term, derived from the Greek word for black, whereas chloasma derives from the Greek word for green. Nevus depigmentosus refers to a congenital hypopigmented patch whose characteristics are unlike what is seen in this patient’s case.

Recent developments in laser therapy offer options for cosmetic improvement of the dyschromia of nevus of Ota.

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.