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.