to RSSNGP02
this is very good news. would you mind posting a link to said journal? please keep us posted with your results. thank you
There’s another article about treating BN with erYAG laser, with the setting details written down. Useful if your dermatologist doesn’t know where to start.
results of both patients seem promising.
ps. I created an account just to share this article. for those who've had treatment, please share your results
Hello all,
I wanted to give some of my input on laser efficacy when it comes to treating Beckers. It’s clear to all of us that there is very limited research on abalative and non abalative corrective laser treatment, with each and every study (maybe 4 on the web) being highly variable.
I would love it if some of our old friends who were making original posts about their preemptive experiences with the ER YAG laser to share with us the outcome of their results. Everyone on this post has provided me with more knowledge than any dermatologist could ever do.
I myself have the nevus on my kneck. VERY EMBARRASSING. Sometimes I only wish I had it as good as other people who have it else where. This nevus is on my face.
Anyway, I recently opted for laser hair removal with the ALEXANDRITE 755NM with CRYOGEN SPRAY to help eliminate the hairs on my kneck. I noticed for the following two weeks after treatment there was severe hyperpigmentation which eventually subsided.
I recommend anyone who is seeking some sort of treatment start with laser hair removal first.
Why?
Because it offers a cheap solution to half the problem. My treatment only costs 50 dollars for a 5 by 4 inch area each session.
Because laser treatment can be a formidable option, especially the ER YAG, with recovery time averaging out a year or more, it only seems logical to treat 1/2 of the problem at a very reasonable price, with zero recovery time (usually).
There also appears to be some lightening of the skin as well.
I will keep updating throughout my treatment. I wish everyone a healthy journey in finding a solution to eliminating Beckers Nevus.
cheers,
David
Initially I thought my BN was a scar haha because when I was around 11 or 12, I clearly remember it as small bumps? sorta like mosquito bites but I guess not. It was a large patcho f dark brown pigmentation on my left breast and two dark patches on the side of my rib cage area. The patches on teh side actually had a different texture. It was semi raised and almost like wrinkles! No visible hair growth though.
After going to several doctors and dermatologist, I was informed it might be a birthmark. One clinic told me it was the cafe au lait? and so I did 3 treatments of Q-switched Yag 5? laser with NO improvement. NADA. I then proceeded to my quest for a more professional and knowledgeable place. I later found another clinic which offered to do test spots for me. My doctor tested (1) Q-switched Yag and (2) KTP. She did several test spots actually. Some on the more flatter skin and some on the more texturized skin. After a month, the Q-switched showed absolutely no sign of improvement yet again. However, the KTP showed almost 30-50% improvement! I’ve had 3 treatments so far and maybe because the area is large, its harder to treat but it has improved. The texture is now much smoother and you can see my natural skin color surfacing. However, she did give me a prescription skin bleaching cream which also helped alot but was very harsh and caused redness which faded to organgy brown so i stopped using it but it peeled a lot of pigmentation off as well…so it was half/half.
I later went to another dermotologist and he diagnosed it as BN which led me here…and he prescribed me steroid cream? to help thin out the skin? and then continue with KTP. I’m trying it for a few days.
Just wanted to share my experience. And overall what I concluded was Q-switched Yag was a not a solution for MY skin. KTP was helpful but pricey ($750! maybe its just the clinic) and I would need maybe another 5 treatments =O.
I also did a little digging for myself on BN and/or pigmented lesions (just to make sure) and the Er: Yag study has indeed struck me as very facinating. Btw, my research was inclusive of both google and scholarly articles/researches. From what I have read the Er:Yag isn’t typically used for BN but it does strip the more superficial pigmentation (moderate sun damage), wrinkles, etc…so one might think it wouldn’t work on deeply pigmented areas such as my BN. However, after using all those creams I was given, I realized that after stripping a few top layers of my skin, the BN was visibly lighter. So in theory, I might conclude that Er:Yag could be a possible treatment. Note that BN was only diagnosed by one doctor and diagnosed as “birthmark” by other doctors. So I cannot be 100% that what I have is BN but I certainly have a lot of similar symptoms.
Enough of my rambling. I am scheduling an appointment with the doctor who did KTP on my skin to see if she is willing to do a test spot using Er Yag that similarly matches the protocols of the previous study. And discuss what other lasers might be effective as a treatment and where to go from here on…
Just wanted to share my experience. 
Hi all,
Just got back from the dermatologist and was told I have BN. after doing some research, I'm hoping that treatment is an option. it's very light, somewhat patchy/spotty, covering the outside of my arm and around my tricep. there is very little dark hair, not more than normal really - just darker. I hope there is something I can do about this, its discouraging since I work out a lot and enjoy it to be strong and look better! I always figured I would get it looked at or 'fixed', but now that the doctor told me there's nothing to do, its pretty depressing... thoughts??
Sorry for the lag is response. Thats a good question and fair point. When my doctor used the Er: YAG, the entire epidermis wasn’t removed. It was red and a little sore for a week or so, but after that period, the redness was gone. (It may be because my doctor told me he wasn’t sure what settings to put his laser on to match the case study). That probably answers the question: The laser was on too low of a setting.
Hopefully youman & Shawn haven’t completely disappeared from this discussion.
I had a test spot done with the ER:Yag laser, and it has turned out very well. It is a tiny test spot, so I can’t say with complete certainty, but the color is nearly that of normal skin (it is just slightly more pinkish, very subtle). It took abut a month to a month and half to come to its present color. I am pleased enough with the result that I intend to get the entire Nevis done. Should that not produce the desired result, I will just get a tattoo over it.
The dermatologist did follow the specifications detailed in the paper (to my knowledge) printed in the British Journal of Dermatology, comparing ER:Yag to Nd:Yag.
Hi Canboy, First of all thanks a lot for starting this thread. I have almost gone thru all 74 pages of comments and gained much info about the treatments which even my Dermat couldnt provide me. I too have a BN and have recently started visiting Dermat for the treatment. Found a good dermat who claims to have treated a few cases (15) of BN. Looking at my BN which is not very dark in color and also doesn't have hair, he feels it should go away in 5 - 8 sittings of LEO 540 laser. I have had 1 sitting 2 weeks back and it has healed as well, but i have not seen much different in the color yet (and i guess it is too early to conclude if it ll work or not). I have my next visit + sitting on 20th Sept'11. I plan to ask him about Er YAG or Fractional ER laser. But meanwhile wanted to check if anyone on this thread has heard of LEO 540 and its results?
Thanks
Kingliam, thanks for your response and for helping to restart this forum. I’ll check out the papers when I get a chance (I’m subdued with exams for a while at present).
When you got the Er:YAG laser, was the entire epidermis removed? I think if so, you might have seen raw, red skin that had to be constantly covered up with gauze and ointments–similar to how you’d treat a burn wound. After the this initial phase, it would have taken several months (at least) for the redness to go away. Did any of this happen? If not, it is possible the setting of the laser was not high enough, like in the parameters discussed in the paper canboy posted.
Of course, I am guessing about the above based on the paper, but youman/Shawn could tell us more about the recovery process.
Like many here, I have BN on my abdomen and have been looking for ways to get it removed for the last few years. I wish I could understand some of the more complex ideas surrounding BN like many of you doctors/med students on this forum.
I actually found a doctor where I’m living that has been willing to work with me and experiment. We’ve created a good friendship and he has been willing to try a number of different lasers. We tried the Er:YAG on a spot for a few months (although we probably ended up doing it on too low of a setting) and didn’t really have much success. We tried spot testing with a CO2 laser and also didn’t find much success. The last few months we have been experimenting with a laser that I think is a Fractionated CO2 laser. (I’ll check with him and give better specifics) We have had varied success and I have noticed the BN area to have faded a little bit.
I’m writing to see what people think about this:
http://www.inwithskin.com/sites/default/files/use_of_long-pulse_alexandrite_laser_in_the_treatment_of_superficial_pigmented_lesions.pdf
Shawn/Youman or even Canboy—do either of you have news of your treatment for Becker’s Nevus.
Thank you very much for your posts. This discussion is still one of the best threads about Becker’s nevus on the internet. Not much has changed since your posts, I am also a medical student, and I have found a Doctor in Pittsburgh (Dr. Barad) who is willing to do the Er:YAG laser, though she warns about risk of hypopigmentation and scarring (she’s never done it on BN before). She is really experienced and open-minded though.
I am also considering the Fractionated Er:YAG option (perhaps before I attempt the fully ablative Er:YAG laser). If neither of those work, then I will just cover it up with a tattoo–assuming that it is safe to tattoo over skin treated with Er:YAG laser.
Alright, I’d be happy to hear from anyone out there who had treatments (with Er:YAG) and wants to share their results.
You should definitely test out the frxel. I do not understand why the docs wouldn’t recommend it. It worked in the study on the face. I would think that the fraxel would have less of a chance of producing adverse side effects than would the q switch ruby. You should try to find a doc with experience using the fraxel to remove pigment. Also what is your email?
I agree with you nm. The thing is, doctors are usually reluctant to try experimental treatments that don’t have proper randomized control trials which these weren’t (well one was but it was really small).
I also think that the risk of adverse effects will be low, but they told me that there is a good chance only parts of the lesion will clear, leaving a high contrast between the brown and white areas which might actually look worse and that I’m not likely to be pleased with the results.
In any case, I’m now moving to Vancouver to start residency, so I’m going to have to find another doctor there with a fraxel laser.
Back to the drawing board 
OK - spoke with the dermatologist. He told me that the consensus by the experts at the laser conference was NOT to treat it, even with a fraxel laser because it is so unpredictable in it’s results. It might work and make it go away, but it can return and it can return all spotty which will look worse. He said one or two dermatologists said it might work but the rest said not to do it.
So he left the ball in my court. He said if I REALLY wanted to try with the fraxel he will do a test patch.
I’m a bit nervous for it to end up looking WORSE than it is now, but I keep thinking back to the case resports where it seemed to work well. I feel like coming this far I should at least try it - or maybe at least do a test on my thigh lesion where it won’t be as noticeable…
I’m going to think about this for a bit, but if I decide to do the test I will let everyone know.
OK, here’s the update:
So I went to the laser update rounds (where there were presentations by all the major skin laser companies) and got examined by at least 30-40 dermatologists who deal with lasers treatment! Admittedly, it was a bit nerve wracking to be examined by so many people, but I’ve done it countless times to others so I suppose it was my turn to be on the other end of the examination table The fact that I have 2 beckers nevi probably helped b/c they were all quite interested in that and said they had never seen that. I suspect if it was only one lesion I wouldn’t have been seen at rounds.
Some of the physicians stopped to talk with me for a bit instead of just running off to see the next ‘exhibit’. I got a chance to briefly discuss fraxel treatment with some of them, which several agreed might be an alternative option to q-switched lasers and MIGHT perhaps work (most have seen the papers or know about the case reports I had posted previously I believe)
In any case, I was one of 10 cases everyone saw (there were other skin conditions being examined there as well) and afterwards, everyone went to discuss treatment options amongst themselves to try to come up with a consensus. As some of the leading north american physicians dealing with laser treatment were there, I’m really hoping they come up with some options (hopefully fraxel!)
I will hear back from my dermatologist next week on what was discussed and whether he will attempt treatment based on the discussion with the other experts. Getting closer here… hopefully this isn’t all one big disappointment, although I feel like I’ve gotten quite far with this so far. Cross your fingers.
PS - FYI i changed my nickname to correspond with one of my email addresses - I’m the same poster who started the thread.
OK, I have some long awaited updates for everyone. I apologize it’s taken this long but I just had my appointment today finally.
First of all, for the post immediately above mine - erbium and fraxel (which is a fractionated erbium) lasers can actually be considered dermabrasion of sorts. Like I mentioned earlier, and in the papers, the erbium laser will coagulate the epidermis and superficial dermis. That’s why it SHOULD work on BN. I’m not sure dermabrasion would penetrate as deep as an erbium, but maybe some very vigorous system can. Using an erbium on it’s on will likely result in results similar to what nickcave posted above, but I don’t know enough about it. The lasers the writer mentioned are likely Q-switched (again, this is the type of laser that almost everyone else has tried). NOT erbium/fraxel.
Now, about my consultation:
I finally met with the dermatologist and he actually seemed very knowledgeable. He found out right off the bat I was a med student and basically cut to the chase. Before I even mentioned the erbium and fraxel papers I read, which I had ready in hand, he mentioned the fraxel paper to ME! Basically, he agreed the Q-switched lasers are likely a waste of time. It takes many many many sessions and results are very variable and not permanent for sure. I already knew this. Erbium on it’s own is very harsh. It can leave permanent redness/scarring etc. The studies performed using one-pass of a high power Er:YAG is not something he would recommend (despite seeing some good results in that study)
Now, as for fraxel. He was intrigued. He’s never come across someone that specifically asked for it, and he’s not completely convinced, since there is still no good evidence (just the 2 case reports I posted) BUT it makes sense, and 5-6 sessions, being fractionated, SHOULD result in no scarring/hyper/hypopigmentation. But hard to know for sure. He’s never done it. He wasn’t ready to commit to doing it himself. Yet.
I got the ‘royal treatment’ of sorts. Usually, he spends only a few minutes with each patient, but sine I’m a med student, he even called over another dermatologist who’s more up to date with lasers. She wanted to see my lesions as well, and they were both very fascinated by the fact that I had TWO becker’s nevi. They had never seen anything like that before. She also knew about the fraxel laser being tried on BN and it’s success in those 2 cases. Also, unsure if it would work. They agreed to present me to laser update rounds, on January 29th, 2009 here in Toronto, where there will be quite a few dermatologists to take a look at my lesions as well as the 2 leading laser treatment experts in north america, who they say will be more familiar with what specific protocol to use with a fraxel. They seemed quite interested in the fact that I had 2 lesions, being incredibly rare, and spent a good 30 minutes with me in total.
Now, the dermatologist I went to told me after, that I shouldn’t expect TOO much at rounds. He’s not sure he’s going to treat me with a fraxel, but he’ll hear what the consensus will be from the experts on it. At best, they’ll try a test spot, and even if that works, I shouldn’t expect miracles. He said that more than likely I will be disappointed by the results. I’m strongly encouraged by the case reports however.
So, in summary: I’ll be presented at grand laser rounds on Jan 29th, to a bunch of the leading dermatologists involved with laser treatment of rare conditions.
I realize this thread and my posts are quite long, but I really hope I can do something to help the BN community. I’m realizing more and more that I’m in a lucky position, being an (almost) physician myself, the doctors I go speak to give me more time than they do most patients and might just be willing to try what I’m asking. I wonder if I would have gotten this attention had I gone 4 years ago.
And, if all else fails - I will buy the fraxel myself once I’m licensed, and just do all the zapping with noone to tell me otherwise 
Oh, and if anyone still needs the papers or has any medical questions about BN or the lasers, just ask away.
Now we wait another month…
Hey guys there is no activity from a very long time … please share your findings.
My only intention is to help few people who can benefit and reduce stress and anxiety BN causes in life. I have a beckers nevus and I have seen some improvement recently using Alexandrite laser. I am aisan and have oilve like skin.
I have done a few treatments for my nevus with decent result. 2-3 years ago I had my nevus treated 4 or 5 times with the YAG laser, and the result came out pretty good. I’d say the nevus was 40-50% lighter in the end, but the downtime was rather long as it was red at least a year after the last treatment. Also there was some hypopigmentation in the end.
Well, so a few months back I found the article on using fraxel on the nevus and I had my first treatment with the fraxel dual today. Lets just wait and see how it turns out. I’ll have my second treatment in two months if this one doesn’t turn out bad.
Hi,
Canboy: Anyupdate from the group of North American Dermatologists? Just read all the posts again and I'm sure the BN community can't wait to hear how things went!
Shawn: Everything ok?
Thanks for the detailed reports so far.