Hori's Naevus at a glance
- Best Results9-18 months
- Treatment Recovery1-4 days
- Procedure Time2-4 minutes
- Skin SpecialistDermatologist, nurse
- Duration of ResultsCan be permanent
- AnaestheticCooling
- Back to Work0-1 days
- Cost$
Hori Naevus
Hori naevus is a form of dermal pigmentation. Other causes of dermal pigment include Ota-Ito birthmarks, acquired dermal pigment such as post-inflammatory & drugs as well as rare causes including silver ingestion. Pico lasers are at the forefront of treating these conditions. Once treated, Hori rarely recur.
FactsFacts on Hori Naevus
- Hori presents as 2-4 mm dark brown dots under the eyes
- It looks like melasma, but Hori is in the dermal layer of skin
- This is one of the most common causes of pigmentation in Asian women
- Once treated, Hori neavus is unlikely to recur
- Pico lasers gives the best outcomes
- Patients require several treatments over 9 months
- Complete removal of Hori is possible
What is Hori naevus?
Hori Naevus
This is an acquired form of face pigmentation that is super common in Asian women. Onset is around 20 years of age. It progressively darkens over the decades. Hori is characterized by dusky grey to blue macules (dots) on the cheeks & around the eyes.
A fancy name is ABNOM or acquired bilateral nevus of Ota like macules. Both entities are due to pigment cells called melanocytes occupying the dermal layer of skin.
Hori is very different from melasma, sunspots, lentigo, freckles & other common forms of pigmentation.
How common is it?
Hori naevus is one of the most common causes of face pigmentation, especially in Asian women. The clinic sees at least three to six cases a week. Not all patients request treatment. It is not hereditary.
Will Hori pigmentation worsen in time if not treated?
Yes, however progression is slow. Some patients elect not to treat. Others elect treatment when make-up cannot cover pigment.
What are other causes of pigmentation associated with Hori?
The majority of Hori patients will also have what dermatologists’ term as non-specific pigment, meaning elements of dusky dermal pigment, spots from sun & age as well as specific pigment disorders like melasma & Ota. It gets much more complex as some may have associated pigment demarcation lines & constitutional periorbital dark circles.
My team & I approach all cases with a diagnosis, as this confers prognosis & treatments. Hence in most cases we use nana & pico lasers with 532, 730, 1064 wavelengths with pigment correctors.
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How do I treat Hori?
I use both nano & pico lasers to treat pigmentation. I do believe that pico lasers give a marginal improvement over nano. Recovery is less dramatic with pico lasers, with less post treatment side effects such as darkening of skin.
I use both Picoway & Picosure lasers to remove Hori.
What is the recovery following a laser treatment?
1-7 days. You can expect some swelling, transient darkening of the skin, swelling & in some cases bruising. I will warn you of the expected effects prior to lasing. It also depends on what lasers we use.
Hori nevus treated with low fluence QSL
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👉Condition: Late onset dermal melanocytosis, commonly seen in Asian women 20-40 yo. Concurrent background melasma makes it challenging to treat in some
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🔫Effective treatment options: QSL nano, 1064> 532, Pico 1064> 532. Traditionally high fluence with 2-4 mm spot size (to get enough energy & end point). This patient responded to low fluence 1064 (failed pico at high fluence). This ‘low power’ technique has been reported in the literature, however most of us use the high power setting
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👌🏻This B+A from the combined talent of our nursing team at Cutis Dermatology
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👩🏽Pigment? Our nurses can manage most cases of pigment, from common causes, to rarer conditions including Hori, Ota, drug induced pigment, traumatic tattoos & constitutional cases. If you have pigment, book a consultation with them. I do get involved in complex cases
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#drdavinlim #skincare #skincaretips #skincarescience #skingoals #melasmatreatment #dermatologistbrisbane #dermatology #horinaevus
#ethnicskincare
Hori naevus
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👉What is it? Super common latent onset dermal melanocytosis, meaning it appears usually in the 20s-40s, usually Asian women .Pigment is primarily in the dermal layer of the skin & consists of BOTH melanocytes & melanin. In some case there is an epidermal component
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🔫Treatment: Nano or pico laser. In this case I use Lutronic Spectra, B+A after 4 sessions with the 1064 3 mm. It takes between 3-7+ sessions to markedly fade Hori. I space my treatments out at long intervals (3 months plus)
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👊🏻Nano vs Pico: Dunno which is better when it comes to efficacy, I suspect the new Lutronic Hollywood Spectra may even have the edge over pico lasers (in terms of efficacy), however pico gives that extra layer of safety especially if there is background pigment as below
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⚠️Be Careful: most cases have surrounding melasma, so be precise with your treatments. Using the 532 to chase epidermal Hori can often lead to worsening of #melasma
Other cases will have intermixed lentigos, macular seb Ks, freckles, regressing lichenoid keratosis & the usual mixed Asian pigmentation. If you can’t name the pigment, don’t shoot it. PIH with dermal drop out makes it much harder to treat in the future
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#melasmatreatment #horitreatment #horinaevus #horinevus #horisnevus #skinlightening #skinbrightening #drdavinlim #davinlim #brisbanedermatoloigst
@lutronicaustralia
Pigmentation is complex. Don’t treat if you can not give a diagnosis. Goto STORIES for an algorithmic approach (Version 1.0, so may still have bugs)
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🔬Skin Science: Many causes of skin pigmentation, ranging from genetic through to inflammatory, drug induced, acquired & neoplastic. It is not infrequent to have 2 or more forms of pigmentation in the one patient
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👉Medical Mx: Tyrosinase inhibitors, VEGF-1 / plasminogen modulators, antioxidants
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🌞Essentials: Photoprotection, physical SPF applied in correct amount & frequency
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🔫QSL/Nano: Still my preferred for #melasma & lentigo in lighter skin types
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⚡️💥Pico: Great for post inflammatory pigmentation, mixed pigment in ethnic skin, select deeper dermal pathology
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💡IPL/BBL: Great for #freckles or mixed pigment in lighter skin types
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👊💥Fractional lasers: great for most forms of epidermal / mixed pigmentation
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💁♀️Tip: Don’t treat if you are unsure of pathology as it can make pigment worse
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😎Dr Davin Lim
Dermatologist
Brisbane🇦🇺
@drdavinlim
#drdavinlim #dermatologistbrisbane #skinejuvenatation #cosmeticclinicbrisbane #dermatology #melasmapigmentation #skinpigmentation #skinlightening #picosure #picoway #skinwhitening #skin #ethnicskin #skinbrightening #dermaltoning #picolasers
What are the side effects of lasers?
Side effects are unexpected outcomes. In the context of lasers for ethnic skin types, transient worsening of pigment can be considered normal & hence is not a side effect. Most of the skin darkening will settle within 2-4 weeks.
If you are stressed with this possible effect, I can prescribe you creams, tablets & special low power lasers to mitigate this event.
How many laser sessions will you need?
Anywhere between 4 to 8 depending on the depth & intensity of Hori, as well as your expectations. Laser sessions are typically spaced 6 to 12 weeks apart.
Once treated, will Hori Naevus recur?
Now for some good news, unlike melasma, the prognosis for treated Hori is excellent. Most do not recur. Note however, most cases are associated with other forms of pigmentation that may recur, these include melasma, sunspots & age spots/lentigo.
Can creams help treat Hori Naevi?
No, as the pigment is deep. Creams can help fade superficial pigmentation often associated with Hori. Many patients have a combination of pigment subtypes including melasma, lentigo, age warts & non-specific sunspots. Pigment correctors including arbutin, azelaic, ascorbic, retinoic & kojic acid can help.
What about chemical peels?
Peels can help with epidermal (superficial) pigmentation. They do not help with dermal pigment. Dermal pigmentation includes Hori, Ota, Ito & dermal melasma.
Are picolasers better for Hori’s?
I am using both Nano & Pico lasers for Hori as of 2021. I did use Picosure from 2014, now I use Picoway & Picosure Pro. Pico lasers give an accelerated initial improvement compared to nano QS lasers. This is reflected in the literature.
The advantage of pico laser is that the rate of PIH (skin darkening after laser) is theoretically reduced, but not eliminated.
What to consider before embarking on treatment?
The first thing to understand is the complexity of pigmentation. In most cases either me or my senior nurses will take many sessions to improve pigmentation. In most cases it can take 12 months or longer to improve pigmentation by about 60-85%.
Even though we use the very best laser technology that is suitable for Asia/ethnic skin types, there are many unknown variables.
How much do lasers cost?
As a guide between $390 to $690.
Costs vary depending on complexity & who performs the laser treatment.
Can creams fade Hori navus?
No. Creams are useful for melasma pigmentation, however they have little impact on treating Hori naevus.
What are other types of pigment that may resemble Hori nevus?
Hori can be tricky to diagnose as in most cases other forms of pigmentation maybe present. This includes conditions such as-
- Melasma
- Post inflammatory hyperpigmentation
- Freckles – lentigo & sun spots
- Flat age warts
How do I get an appointment for pigmentation removal in Sydney?
As of 2024, I am seeing select patients in Sydney. For an expression of interest, please contact Dr Van Park’s clinic in the Eastern Suburbs.
Davin’s Viewpoint on treating Hori Naevus
Hori’s is a super common condition in Asian women, literally see one every day, however not all require treatment. The treatment is straightforward- Pico laser or nano with specific parameters. Persistence is the key. As reflected in the literature, we can expect to get 80-90% improvement in Hori, but that takes 12 to 18 months. Sometimes longer.
What is difficult are the other forms of pigmentation associated with Hori, including mixed depth melasma, non-specific dermal pigmentation (probably from regressed lentigos including lichenoid keratosis), lentigo-macular seb keratosis overlap, & the dearth of conditions associated with periorbital dark circles, including pigmentation demarcation lines, post-inflammatory, post treatment purpura (microneedling PRP to blame), contact dermatitis, constitutional pigment, & race associated pigment, vascular changes as well as aging factors (fat atrophy) & anatomical changes including tear thoughts. Pigment is not just pigment. If one identifies the type of pigment, & applies accurate treatments, the vast majority can be improved. Unless the cause-causes are constitutional & or demarcation lines.
It is important to remember that lasers are not the only answers to pigment, however with the advent of technology, Pico lasers are very useful, especially in Asian skin types.
