Effective treatment with the Er:YAG laser? A potential 'cure'


I’ve been following the board for a while now, and have been looking into treatment for becker’s nevus for several years as well. I’m currently 27, and have TWO becker’s nevi. One relatively large one on my thigh and a fairly large one on my abdomen. Luckily, both are relatively light and none are hairier than the surrounding skin.

Being in medical school, I suppose I am somewhat luckier than most in that I have access to a variety of specialists who I can ‘corridor consult’ at any time, as well as access to peer-reviewed literature. I’ve done some extensive research (as I’m sure many of you have) and have found work in the field rather lacking as it is quite rare in the general population. Of the many dermatologists and plastic surgeons I have consulted, most are of the opinion that there is no real effective treatment in terms of topical medication or laser therapy. Of course, with many other areas to stay abreast of in their fields, specifically keeping up to date with laser treatment for one specific very rare condition is likely not on the top of most physicians’ lists.

Having said that, most studies and treatment attempts are made using the Q-switched Nd:YAG (neodymium) laser. This is the laser that targets pigment cells. This is also likely the laser that many of you have tried treatment with, but have seen eventual recurrance with.

I have found two papers related to a single study performed in spain on 22 patients reviewing ‘standard’ laser therapy using a Q-switched Nd:Yag laser and the relatively unconventional use of an Er:Yag (erbium) laser, which is more often used for dermabrasion and other procedures.

While recurrance of the nevus was shown after several months in almost all patients treated with the standard Nd:YAG, VERY good clearance with minimal hypo/hyperpigmentation or redness was found in almost all of Er:YAG treated individuals. (54% had 100% clearance at 2 years follow-up while the rest had > 50% clearance at the same time - still amazingly good!) Almost NONE of the Nd:Yag treated individuals (which is probably what most people treating Becker’s nevi would think to use) had clearance at 2 years, even though they were treated with the laser THREE time. The pigment invariably returned fully by then.

The most impressive part of this is the fact that a SINGLE pass with the Er:YAG laser was made. I believe some clearance of hair was shown as well.

Admittedly, there are some caveats to the Er:YAG, mainly that treated skin remains red for several months as opposed to much shorter recover with the Nd:YAG. This does mostly clear with time however. Given that Er:YAG results in seemingly great clearance as opposed to POOR clearance with the Nd Q-switched, I’d take Er any day! (you must see the photos to believe it)

Now before everyone jumps and says finally a cure has been found, keep in mind that the study involved only 22 patients, only 11 of which were treated with the erbium laser. While the power of this study is somewhat small (given only 22 patients) the impressive results still speak to me.
Up until now, hearing other’s results with laser therapy and it’s poor outcomes, I’ve decided against treatment for the time being. I am, however, seriously contemplating the user of the Er:YAG and will be scheduling a consultation later this month with a physician that uses one. Even if pigment returns after a few years, I wouldn’t mind doing a single pass with one of these lasers every once in a while. It seemingly beats the Q-switched Nd in terms of recurrence any day.

I would be happy to post the two papers (with corresponding photos) here for people’s perusal.

I’d also be very interested in hearing about results obtained by anyone else who has attempted treatment with the Er:YAG laser. I have a feeling the # of people having tried this laser is low however, since it’s not a laser that is generally used to treat pigmented birth marks (it’s used for other cosmetic procedures).

A cure? I’m not holding my breath, but I’m VERY intrigued by this.

Hello all,

any updates from canboy or youman?

Youman I wish everything goes well!
Thank you for all the info it is really interesting.
Have you seen any improvement so far? Is it painfull?

Hi youman,

Just wondering if there’s any progress, I’m sure a lot of people are waiting to hear about the results, good or bad…


I’m 22/F, i’ve had BN since I was 16ish, but now its starting to bug me again. I went to a dermatologist in Vancouver, but found that they do not have any cure, but this laser you are talking about sounds hopeful. Wishing you the best!!! Let us know how it goes :smiley:

Thanks for the information, I’m sure many of us would love to see the photos if you do post them. I, for one, will be printing out your email for my daughter’s dermatologist visit!

I do appreciate the tip.

(concerned mom of BN teen)

I’ve posted the two journal papers describing the study with photos here for anyone who is interested:


I can only leave it up for a short time since I have limited bandwidth, so try to download it to your computer as soon as possible.


Wow, thanks a lot for posting the papers. Lately I was debating a tattoo, but this really seems promising.

I had a test done with a Yag some time ago, but im 99% sure it was the Nd: Yag. I think I’m most impressed that in the study it was only taking a single pass to get these results not 6 or 7.

The results for the Nd: Yag also seem similar to what I’ve seen from the people who have chosen to have treatment with it, which I think is good because it shows that the study is probably accurate.

Also by taking only one pass the price for treatment would be much more reasonable for people. I know the test group was small, but it does seem like a possible treatment and like you said even if there is reoccurrence it wouldn’t be a huge undergoing to have only one pass every 2 years or so.

I tried to find some more information on it and find some other people that have tried the Er: Yag, but have not found anyone. It does always seem to be the Nd: Yag that people have tried. If anyone else on this board has tried or knows of someone who tried the Er: Yag I would be really interested to hear about the results good or bad. I think I might look around for a nearby Er: Yag myself but I’m not sure how common they really are.

Considering one pass probably would be cheaper then a decent tattoo anyway I think it would be worth a try even if it did fail.

Thanks again for posting this, good luck and keep us updated…

Er:YAGs are relatively common, generally they’re used for skin resurfacing, removing wrinkles etc, although I think the output power used is lower than that for this study. You should be able to find them at many laser skin care clinics. Derma-K and Sciton are two Er:YAGs in common I think use but you’ll have to call the individual place to see if they actually have one that is erbium and not an Nd.

Also, I guess the place you go to would have to be willing to use specific parameters for the laser that you dictate. I’m not sure how many would be willing to do that and I’m not sure if different fluence energies or beam diameters would work the same if they chose to use their own settings on the laser…

Ya, I’ve been doing some more research lately. You’re right its typically used for skin resurfacing and I’m guessing most skin care places and even dermatologists would give you a funny look if you wanted them to use the Er: Yag to correct BN. Which is why I’m glad you posted the study so I will have something to back me up and it gave a fairly comprehensive look at the parameters they used…

“2940-nm wavelength, 3-mm beam spot with a collimated
handpiece, fluence energy of 28 J cm)2, 10 Hz repetition
rate, and 50% overlapping, one pass only.”

I’d probably only give this one shot, but would be pretty insistent on using the same parameters as the study. I’m sure many places will want to start with much lower settings so they can get you in for at least 3-5 sessions and really empty your wallet. I’m still totally shocked that the results were done with a single pass.

Anywayz, do you have any clue if the erbiums at skin care places would be able to run at those parameters, it seems like they are typically used at lower settings. However, I’m guessing it would probably be half the cost or less. Any other reason that they would be inferior? Like you said I’m not sure how many would use the erbium with the specific parameters given, but I would plan on getting a test spot done first. Also I’m sure I would have to sign some waivers, but hopefully I’ll be able to find someone that will do it using the parameters in the study on the first shot.

I’ll be making some calls and hopefully find something close and be able to at least get a test spot done in the next month or so. And I’ll try to keep everything in order, take down all the info and some pics to post up afterwards with the results good or bad.

Thanks again for all the info and help!

How much does a laser treatment cost?

“How much does a laser treatment cost?”

Cost depends on many factors, but I can maybe give you a ball park. My bn is on my chest and about the size of my hand. For the Nd: Yag I was looking at 600-800 dollars “PER” treatment session. In the case of the Nd: Yag the number of sessions would be totally unknown and most likely would have failed (I did have test spots which did not respond at all to the Nd: Yag). I’m not sure about the Er: Yag, but price will probably be similar. There may be a skin care clinic that would do it for cheaper (remember cheaper is not always better), but I’m going to guess anywhere from 200-800 per session plus initial visit and testing might be another 200-300. Its a good idea to try and get your insurance to cover it, but its very unlikely they will pay any of it. Obviously it depends on the size, it depends on number of treatments, it depends on doctor, it depends on the laser, so the only real way to find out is to talk to some doctors who ofter laser treatment…

Some things to know…

Like what ‘canboy26’ said, this was a small study that we are looking at and as of now I don’t think anyone can be sure that any laser is going to really work, so realize you might be throwing your money away.

My personal ‘opinion’ is that laser treatment for the ‘pigmentation’ in BN is a waste of money with any other type of laser besides the Erbium. Although the Erbium might not be as good as we would think, it seems to be the only thing that ‘MIGHT’ be worth the money. So if you see a doctor that wants to use something else, even if he makes it sound good it might not be in your best interest.

I believe the parameters used in the study are very important, if you read the study one of the major differences between the Nd and the Er was that the Erbium ablated(vaporized/destroyed) the epidermis completely and partially ablated the papillary dermis while the Nd only partially ablated the epidermis. If the Erbium was used with different parameters it may not work at all or yield similar results to the Nd. So if your going to go through with it try to be informed; ask the doctor questions, know the type of laser he is using, what settings hes using it on, and how hes using it, etc…

Also I’ve realized that using the Erbium at such powerful settings CAN likely have some side effects such as hypo-pigmentation/redness that can be permanent. To an extent it’s actually probable that you will come away with some degree of hypo-pigmentation/redness that may persist for years or be permanent. However it may be very small and very unnoticeable (esp. when compared to your BN). In my opinion it’s important to have a small test spot done first and realize that there are some risks involved. Also it seems like these side affects are more likely to be present in fair/light skin people (like me).

The study does suggest it helps to minimize the hair, but stated that it returned with the Erbium. Personally I don’t mind dealing with the hair myself while others seem to be much more concerned about the hair present within the BN. While there are other options for removing the hair I believe it is likely that the Erbium will NOT totally solve the increased hair growth in most people.

Hopefully this might help someone that may not be to well informed with BN and treatments, I know I could have used more of this 3 years ago when I was really searching for a cure. Personally I was set on getting a tattoo in about a month, but want to try this Erbium not just for myself, but hopefully to help some others in the process.

As of now I’m still doing my own research trying to understand everything much more completely myself, but if anyone has some questions I would be more then glad to try and help.

ps I typed this post fast and its 4am so if I made any major errors or stated something incorrectly please correct me. I don’t want to steer anyone wrong here, just hoping to help out a few people who may read this post.


I’m really not sure if the lasers in common use are equivallent to the derma-K that they used in the study, but I’m trying to find out. My guess is that they should be able to be used with the same parameters (ie higher power output). It’s important that the power is high enough to burn through to the superficial dermis but not too high to burn off the entire dermis which is why I’d definitely use the settings they used.

One thing to keep in mind is the 50% overlap… even though it was one pass it was kind of like 2 since 50% overlap is in effect ‘two’ passes over every point (except the outer edges where they didn’t do this). I wonder how adept the technicians will be at doing this…

Also, not sure if it makes any difference, but the other instructions such as the steroid cream and dressing might be important as well to reduce the subsequent erythema.

I’m half tempted to do a derm elective and just laser myself when noone is in the office haha.

Keep us posted guys. I’m watching! Thanks for all the information.

I’m still finishing up university, so paying for treatment is as expensive as my tuition. Anyways, I’m looking into this as well. Thanks for the information guys!

Will this treatment be common to adopt…?

Hey canboy26,

Fascinating review - are you interested in trying out this laser later this
month or are you just meeting to discuss it? I unfortunately do not have
the money to try various lasers on my skin, otherwise I might. Mine isn’t
that bad, though.

Let us know how things go - and please keep me personally updated – you can message me on my profile.


Wolven - I really can’t say if this will be ‘common’ treatment. Since becker’s nevus is so rare I doubt any treatment will be ‘common’ really. It IS a common laser in use at skin treatment clinics though, so you should be able to find one.

Anyway, I tried contacting a few places but being in med school and working 80+ hours in the hospital each week it’s very hard to find time to actually go for an appointment (+ the closest collection of potential places is in Toronto, and although that’s home, it’s a 2 hour drive for me and I’m only there on weekends when places are closed) Even though I have two separate lesions, they really aren’t THAT bad and I’ve lived with them for so long that I can wait another few months when I actually have a few days off to go see someone.

In any case I WILL post updates as they come but it might be a while. If anyone else goes for the Er:YAG please keep us all updated too.

Anyone else from Toronto BTW?

I’m from vancouver, but I have relatives and friends in toronto. Not really sure when my next trip there is going to be. Do laser treatment cost the same everywhere in canada? I was looking up websites for vancouver lasers and I think I’m looking anywhere from 4000-6000. Any idea if it would be covered under insurance? Probably not right coz its cosmetics?

jp36: ya I’m located in the U.S. so I have no clue if there would be a big difference in price between us. However, I really doubt it would be anything close to 4000-6000. Using any other lasers like the Nd: Yag you would probably need at least 5-10 treatments to “Maybe” get any kind of results (tho even after 10+ many ppl see little to no improvement). If that was the case then that might be a fair estimate considering how many sessions will be needed. It’s probably not a good idea to get to hopeful on the Erbium laser yet, but one of the benefits is that you should only need 1 or 2 sessions (granted everything is done very similar to the studies provided). Considering the sessions do not take very long (Probably 15-45min depending on the exact laser, some are much quicker then others) and in many cases the doctors leave a lot of laser work to trained nurses because the procedures don’t usually demand a real high level of skill (but in our case with a rare skin problem using a fairly unknown treatment I would hope it would be the doctor rather then a nurse doing the procedure). The point being for 30 min. of work 4000-6000 would be a joke and I really hope that they do not charge that much in Canada. If for some reason it does cost that much in Canada you could take a vacation, fly to the US first class, stay at a nice motel, get the procedure done and still save money. Also like canboy26 said the laser is a common laser, another reason it shouldn’t be that expensive.

So I called around and actually found some Erbium lasers nearby!!! but I decided to see a past dermatologist that I trust first(I have had some not so good or truthful doctors in the past, so I don’t want to rush into it to fast). I’ll be making an appointment tomorrow, I want to see what he says about the studies, and if he doesn’t have an Erbium(I’m actually not sure) then see if he can recommend a good doctor that does. Also should have some extra money coming in at the end of the month and will basically try to get in for a treatment somewhere as soon as I can after I get that.

I did find out that some of the Erbium lasers out there can’t run at the parameters used in the study. I actually saw one Erbium laser that couldn’t even run half of the power. Still not sure if the ones that can run at the same parameters could possibly be inferior in any way. If everything works out maybe I’ll be able to find a decent doctor with a derma-k.

Well good luck to everyone…