title: Ablative fractional laser therapy as treatment for Becker nevus: a randomized controlled pilot study.
abstract: BACKGROUND
  Becker nevus (BN) is an uncommon pigment disorder characterized by hyperpigmentation and sometimes hypertrichosis. To date, no effective treatment has been available.
  
  
  OBJECTIVE
  We sought to assess efficacy and safety of ablative 10,600-nm fractional laser therapy (FLT) in the treatment of BN.
  
  
  METHODS
  Eleven patients with BN, older than 18 years, were included in a prospective randomized controlled, observer-blinded split-lesion trial. In each patient two similar square test regions were randomized to either ablative FLT at 10 mJ/microbeam, coverage 35% to 45%, and topical bleaching (to prevent laser-induced postinflammatory hyperpigmentation), or topical bleaching alone (to allow comparison of the regions). At 3- and 6-month follow-up, clearance of hyperpigmentation was assessed by physician global assessment, reflectance spectroscopy, melanin index, patient global assessment, patient satisfaction, and histology.
  
  
  RESULTS
  At 6-month follow-up, physician global assessment improved in the FLT region (P < .05). Reflectance spectroscopy, melanin index, number of melanocytes, and amount of dermal melanin did not significantly differ between the regions. Patient global assessment and patient satisfaction were 5.0 and 5.9 (visual analog scale score, 0-10), respectively. Side effects were postinflammatory hyperpigmentation (n = 3), erythema (n = 3), burning sensation (n = 3), crusting (n = 3), edema (n = 2), and blistering (n = 2).
  
  
  CONCLUSIONS
  Limitations include the small number of patients, treatment in spring, possibly suboptimal laser settings, and the combined usage of FLT and a bleaching agent.
  
  
  CONCLUSIONS
  Ablative FLT was moderately effective in some patients with BN. However, postinflammatory hyperpigmentation and relatively negative patient-reported outcomes still preclude ablative FLT from being a standard therapy. Larger studies with different laser settings will be required to optimize this treatment modality.
authors.affiliation: The Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Arne A
authors.initials: AA
authors.lastname: Meesters
authors.forename: Bas S
authors.initials: BS
authors.lastname: Wind
authors.forename: Marije W
authors.initials: MW
authors.lastname: Kroon
authors.forename: Albert
authors.initials: A
authors.lastname: Wolkerstorfer
authors.forename: J P Wietze
authors.initials: JP
authors.lastname: van der Veen
authors.forename: Ludmila
authors.initials: L
authors.lastname: Nieuweboer-Krobotová
authors.forename: Allard C
authors.initials: AC
authors.lastname: van der Wal
authors.forename: Jan D
authors.initials: JD
authors.lastname: Bos
authors.forename: Johan F
authors.initials: JF
authors.lastname: Beek
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009506:Nevus / Q000601:surgery*; D010865:Pilot Projects; D011446:Prospective Studies; D016037:Single-Blind Method; D012878:Skin Neoplasms / Q000601:surgery*; D055815:Young Adult