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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 173-175

Bilateral nevus of Ota: unique presentation


1 Senior Resident, Department of Dermatology, Venereology, Leprosy, Kasturba Medical College and Hospitals, Manipal, Karnataka, India
2 Department of Dermatology, Venereology, Leprology, Lady Hardinge Medical College, New Delhi, India

Date of Submission01-Mar-2021
Date of Decision10-Apr-2021
Date of Acceptance21-Jun-2021
Date of Web Publication24-Nov-2021

Correspondence Address:
Dr. Rashmi Sarkar
Department of Dermatology, Venereology, Leprology, Lady Hardinge Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/Pigmentinternational.Pigmentinternational_

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  Abstract 


Nevus of Ota (NOO) is a dermal melanocytoses characterized by bluish-brown macules along the distribution of trigeminal nerve. Ocular involvement is observed in most of the patients in the form of scleral pigmentation. Also reported associations in this condition are iris/ciliary body pigmentation/glaucoma, ocular melanoma, etc. Hence, the terms nevus fusco-ceruleus ophthalmo-maxillaris and oculodermal melanocytosis are used to refer to this condition. Bilateral NOO is a rarely encountered condition, with only few scattered case reports in the literature. In this study, we report a rare presentation of bilateral NOO in four patients. The condition is important to recognize due to cosmetic concern it poses and limited treatment options.

Keywords: ABNOM, bilateral, dermal melanocytosis, nevus of Ota


How to cite this article:
Hegde P, Sarkar R. Bilateral nevus of Ota: unique presentation. Pigment Int 2021;8:173-5

How to cite this URL:
Hegde P, Sarkar R. Bilateral nevus of Ota: unique presentation. Pigment Int [serial online] 2021 [cited 2021 Dec 6];8:173-5. Available from: https://www.pigmentinternational.com/text.asp?2021/8/3/173/330895




  Introduction Top


Nevus of Ota (NOO) is a dermal melanocytosis characterized by bluish-brown colored macules along the distribution of trigeminal nerve. Also observed in this condition is the ocular involvement in the form of scleral pigmentation, present in most of the patients. Hence, the synonyms nevus fusco-ceruleus ophthalmo-maxillaris and oculodermal melanocytosis are used to refer to this condition. In this study, we report a rare presentation of bilateral NOO in four patients.


  Case report Top


Case 1

A 18-year-old female patient presented to the dermatology department with a history of dark-colored lesion on both cheeks since birth. On examination, ill-defined, bluish-brown colored macules were present over bilateral cheeks extending up to the temples and forehead [Figure 1]. Similar bluish discoloration was noted on the right side of hard palate.
Figure 1 Bluish-brown macules in speckled manner over both cheeks and forehead.

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Case 2

A 22-year-old female patient presented with similar dark colored lesion as in case 1 which was present since her childhood. Examination revealed bluish-black colored macules on bilateral cheeks extending till temples and forehead [Figure 2]. This patient also showed scleral pigmentation as in case 1 and demonstrated bluish lesion at the middle of hard palate.
Figure 2 Dark bluish-brown macules in speckled manner over both cheeks, temple, and forehead.

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Case 3

A 21-year-old male patient presented with a complaint of similar lesion but only on the left side of the cheek since birth. On examination, bluish-black macules were noted on left cheek, extending to the left-side nose [Figure 3]. On further examination, scleral lesions were found to be bilateral and oropharyngeal mucosa was free of lesions.
Figure 3 Bluish-brown macules over left cheek, extending to temple and lateral side of the nose.

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Case 4

A 13-year-old girl child was brought by her mother with a complaint of dark colored lesion over the face for the past 3 months. On examination, the patient demonstrated bluish-black macule over bilateral cheek and temples. Extensive scleral bluish discoloration was noted bilaterally [Figure 4]. Multiple bluish macules of similar morphology were present on the hard palate and gingival mucosa.
Figure 4 Bluish-brown macules in speckled manner over both cheeks and forehead and extensive and deep bluish discoloration of bilateral sclera.

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Ophthalmology referral was performed in all the patients and all four of them were free of iris/uveal/choroidal/retinal pigmentary changes/nevi and malignancy. Systemic examination was within normal limits in all four patients. We were not able to perform the dermoscopic examination and skin biopsy could not be carried out as the patients denied the procedure for cosmetic reasons and few were lost to follow-up.


  Discussion Top


Bilateral NOO is a rare entity and constitutes around 5% cases of NOO.[1] Adequate history with specific emphasis on the onset of the lesion and examination of mucosa are crucial to differentiate it from acquired bilateral NOO-like macule (ABNOM). Few cases of bilateral NOO are reported from Indian population,[1],[2] few from other Asian population,[3],[4] and from western literature.[5] We hereby report four cases of bilateral NOO. One of our case was unique, the patient had unilateral skin involvement to present with, and careful examination revealed bilateral scleral involvement, very distinct from previously reported cases in the literature. Q switched Nd:YAG lasers are advised for the treatment of NOO. However, due to unavailability of this facility at our institute, cosmetic camouflage was advised. The closest differential diagnosis is ABNOM. The key differences between bilateral NOO and ABNOM entities are summarized in [Table 1], few of which helped us to diagnose NOO in our patients. Another close differential for NOO is melasma, which should be considered especially in a Southeast Asian female patient presenting in her middle age. The differences between the two entities are summarized in [Table 2].
Table 1 The differentiating features between NOO and ABNOM[1],[2],[3],[4],[5],[6],[7]]

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Table 2 The differentiating features between NOO and melasma[1],[2],[3],[4],[5],[6],[7]]

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Declaration of the patient consent

The authors certify that patients’ consent has been obtained for photographs, their details to be published, and patients understand that their identity/name will not be revealed.[7]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gangopadhyay KA. Bilateral nevus of Ota. Indian J Dermatol Venereol Leprol 2000;66:104-5.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Adil M, Amin SS, Raj D, Alam M. Bilateral nevus of Ota with involvement of palate: a rare case report. Indian J Paediatr Dermatol 2018;19:290-2.  Back to cited text no. 2
  [Full text]  
3.
Syed MMA, Amatya B, Alam S. Bilateral nevus of Ota. Pigment Int 2018;5:120-2.  Back to cited text no. 3
  [Full text]  
4.
Tateishi C, Ozawa T, Shirakawa M, Tsuruta D, Ishii M, Harada T. Bilateral nevus of Ota: a rare manifestation congenital type in boy. Osaka City Med J 2011;57:45-8.  Back to cited text no. 4
    
5.
Turnbull JR, Assaf CH, Zouboulis C, Tebbe B. Bilateral naevus of Ota: a rare manifestation in a Caucasian. J Eur Acad Dermatol Venereol 2004;18:353-5.  Back to cited text no. 5
    
6.
Sonthalia S, Jha AK, Langar S. Dermoscopy of melasma. Indian Dermatol Online J 2017;8:525-6.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Elmas OF, Kilitci A. Dermoscopic findings of nevus of Ota. Balkan Med J 2020;37:116-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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