Facial melanosis is a group of heterogeneous entities, sharing a
common clinical feature of altered pigmentation of the face and thus easily visible
cosmetic disfigurement and significant psychosocial consequences.
Facial and neck pigmentations are common in middle-aged women, and are
related to endogenous (hormones) and exogenous factors (such as use of cosmetics and
perfumes, and exposure to sun radiation i.e. sun tanning).
Various causes of facial melanosis are:
Sun tanning, Melasma,
Post-inflammatory hyperpigmentation (PIH), Drug-induced hyperpigmentation Lichen Planus
Pigmentosus (LPP) and
Erythema dyschromicum perstans
Riehl's melanosis,
poikiloderma of Civatte, erythrose peribuccalepigmentaire of Brocq, erythromelanosis
follicularis of the face and neck, lineafusca, and
Cosmetic hyperpigmentations.
Melanosis tend to have a
prolonged course and, in many cases, are refractory to treatment.
A range of treatment modalities are:
Removal of aggravating
factors: like avoiding the sun and applying cosmetics and perfumes, Vigorous
photo-protection like using appropriate sunscreens and Some form of depigmenting agents
– such as:
Topical hydroquinone 2 to 4%
alone or in combination with Tretinoin 0.05- 0.1%
Topical Azelaic acid 15 to 20%
Kojic acid, alone or in
combination with glycolic acid or hydroquinone, and topical retinoids, and various other
cosmeceuticals.
Q-switched lasers and Pico lasers.
The above mentioned treatment
modalities, when used alone or in combinations, are effective in improving melanosis but
some of the conditions especially melasma can recur and may require continuation of
topical skin lightening agents in conjunction with rigorous sun protection.
The nevus of Ota is a
distinctive, congenital, benign, bluish grey pigmented lesion, which usually occurs on
one side of face, affecting particularly the skin of eyelids, the cheeks, forehead,
scalp, nose and ears.
It also involves sclera
(white visible part of eye) and conjunctiva. It may appear at birth or at early
childhood and slowly increases in size till puberty. Rarely does it appear on both sides
of face. It was first described by Ota in 1939. The condition is uncommon in India. It
is very rare in male patients.
The main problem is usually
cosmetic but different complications may appear. Glaucoma (increase in eye pressure
associated with headache) appears in approximately 10% of patients. The most serious but
unusual complication is the development of malignant melanoma on pigmented areas.
Nevus of OTA can be
effectively treated with Q-switched Nd:YAG laser. Treatment is given once in 6-12 weeks
and it may take anything between 8-12 treatment sessions to achieve 80%-95% reduction in
skin pigment. Pigment in eyes (sclera) cannot be reduced by any means
