- Best Results9-18 months
- Treatment Recovery1-4 days
- Procedure Time2-4 minutes
- Skin SpecialistDermatologist, nurse
- Duration of ResultsCan be permanent
- Back to Work0-1 days
Hori nevus 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.
FactsFacts on Hori Nevus
- This presents as 2-4 mm 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 nevus is unlikely to recur
- Pico lasers gives the best outcomes
- Patients require many treatments over 9 to 18 months
What is Hori nevus?
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 nevus 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.
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.
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 10 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 nevus 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. I do find that pico lasers give a modest to moderate 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 $540 out of pocket.
Costs vary depending if you have just Hori or associated pigment (most cases). In some cases, there may be a Medicare rebate.
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.
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