Becker’s nevus also goes by the names – becker’s melanosis, becker’s hamartoma, nevoid melanosis, and beckers pigmentary, all indicating hyperpigmentation and hypertrichosis. This condition can be very embarrassing and is capable of blowing your self-confidence away. This Becker’s nevus syndrome is often associated with other abnormalities, and thus it is very important to clinically treat this condition by consulting a qualified cosmetic Dermatologist and Trichologist.
What Is Becker’s Nevus?
Becker’s nevus is a skin condition, which mostly affect men. The nevus can be present from birth or can eventually appear around puberty as well. It is recognized as irregular appearances of pigmentation on the body, majorly the upper trunk of the body or upper arm, and gradually ageing, it enlarges, darkens, and thickens, and often tends to become hairy.
It is caused by the overgrowth of the upper-most layer of the skin, hair follicles, and pigment cells in the affected area. Although, the core cause of this syndrome is unknown, but it is associated with puberty, acne, and hair growth, and is known to be triggered by androgens. Sometimes, Becker’s nevus comes along with other additional issues, such as underdevelopment of the breasts, or muscular or skeletal issues.
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Who Gets A Becker’s Nevus?
Becker’s Nevus is a rare skin condition that typically occurs during adolescence or during early childhood. It is a non-cancerous, large, brown, hairy patch on the body.
Although, it occurs in both men and women, but men are known to be more affected by this syndrome by a ratio of 5:1.
Symptoms Of Becker’s Nevus
Becker’s nevus often develops during puberty or early childhood, on the shoulders, or the upper trunk of the body. The symptoms include pigmentation, which often darkens, and widens after puberty, resulting in a large, brown, hairy patch on the body. This patch tends to be hairier than the surrounding skin, and in some cases, this patch also develops acne.
Additionally, this syndrome may cause some skeletal and muscular abnormalities, such as –
- The absence of the pectoralis major muscle (pectoral)
- Underdevelopment of the shoulder girdle muscles
- Vertebral defects
- Fused ribs
- Abnormal curvature of the spine
- Underdevelopment of the jaws and teeth
- Supernumerary nipples
- Abnormally sparse hair under the armpit.
- Ipsilateral shortness of a limb
- Sunken chest or abnormally prominent chest
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What Causes Becker’s Nevus
Although the causes of the formation of Becker’s nevus are relatively unknown, research suggests that it is due to genetic mutation.
So, the probable causes are –
- Etiology – Evidences suggest that a probable suspect is sensitivity to androgen, and it can increase the probability of hypertrichosis, sebaceous hypertrophy dermal thickening, acanthosis, and co-localized acne. Furthermore, the condition worsened due to excessive exposure to sunlight, and this sun exposure is considered to be an additional trigger point.
- Pathophysiology – Becker’s nevus shows a lot of signs similar to epidermal nevus syndrome, including breast hypoplasia, extra nipples, and certain skeletal abnormalities. And, in some cases, this syndrome starts as verrucous and linear initially before developing into hyperpigmented and hypertrichosis condition. This syndrome has both sporadic and familial occurrences.
- Systemic Implications and Complications – It is a benign lesion, commonly associated with ipsilateral breast hypoplasia. The breast hypoplasia is because the lesion ridden skin tissues contain excessive androgen receptors, which counteract the development of breast that is estrogen dependent.
- Other abnormalities include – scoliosis, limb asymmetry, vertebral anomalies, facial asymmetry, fused or accessory ribs, accessory scrotum, hypoplasia of the contralateral labium minus, asymmetry of the scapulae, decreased hairiness of the ipsilateral axilla, and supernumerary nipples.
Also Read: What Causes Nevus Depigmentosus?
Treatments For Becker’s Nevus Removal
There is no one treatment for this syndrome, as it is a combination of a lot of skin conditions. The following treatments are possibly effective in treating Becker’s nevus –
1) Laser Treatment
The becker’s nevus laser treatment is divided into two components – removal of excess hair and reduction of the hyperpigmentation.
- Long-pulsed lasers are known to work effectively on both hypertrichosis and hyperpigmentation, as the heat energy that is generated by the laser, penetrates into the deeper layers of the skin and is easily absorbed by the hemoglobin and melanin chromophores of the body. The success rates of the laser therapy are as high as 75%.
- Q-switched and Nd:YAG lasers – Q-switched ruby and Q-switched Nd:YAG targets the epidermal and dermal melanin without damaging or causing any harm to the epidermis. Q-switched ruby laser has proved to be successful in treating both hyperpigmentation and hypertrichosis. But, re-pigmentation was a problem that was reported by many, which was due to the persistence of hair follicle melanocytes.
- Fractional Laser Resurfacing – In this process the laser uses carbon dioxide to resurface the photodamaged skin by clearing the skin using the heat energy layer by layer and this treats the skin discoloration. To nullify the damage caused by the thermal energy, pulsed and scanned CO2 systems are added, so as to remove layers in a controlled manner. Additionally, fractional resurfacing effectively and safely lightens the deep pigmentation caused due to this syndrome, but this was ineffective on hypertrichosis.
Thus, a combination approach with non-ablative fractional laser and long-pulsed Nd:YAG laser in a sequential manner over time, has proved to show a great amount of clinical improvement.
In some cases, after treating the pigmentation and excessive hair growth problems, via Q-switched Nd:YAG laser or fractional resurfacing, standard acne therapies are also required.
2) Laser Toning
Laser toning uses non-ablative lasers and uses heat energy to break the pigmented cells of the targeted tissues. Thus, in this process, the laser energy penetrates into the skin and dissevers the pigment cells, thus dissolving them into the tissues and diminishing their appearances.
Becker’s nevus, in most cases, is too big to be surgically removed, therefore different types of laser systems are used to treat both the pigmentation and excessive hair problems that are caused due to this syndrome. The laser therapy may cause damage of superficially located melanocytes, but the remaining pigment cells showed transient improvement clinically.Additionally, it is also important to note and investigate the other abnormalities that are caused by this syndrome.
3) Other Treatments
Becker’s Nevus syndrome causes two problems – Excessive hair and pigmentation. In addition to lightening the pigmentation caused by this syndrome, by using topical creams that are available over the counter, which contain ingredients like kojic acid, retinoids, AHAs, licorice extract, ascorbic acid (vitamin C), and tranexamic acid, you will have to treat the excessive hair problem by –
- Laser hair removal – Advanced laser technology is used to permanently get rid of excess unwanted hair by targetting the pigments under the skin. This destroys the hair follicles completely and renders further hair growth ineffective.
- Electrolysis – This process helps in removing the excessive hair growth on the affected patch of the body with chemical or heat energy.
- Shaving – This process helps in stripping off the patch of excessive hair from the body using hot wax.
- Topical flutamide is proved to efficiently reduce hyperpigmentation and diminish the dark patches caused by this condition.
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Laser Vs Plastic Surgery For Becker’s Nevus
The traditionally used surgical approaches cannot be used to treat or remove Becker’s nevus, as they are either unsuccessful or can result in significant scarring. On the other hand, laser technology provides a solution to reduce both hyperpigmentation and hypertrichosis clinically. Plastic surgery may help in reducing the appearance of the patches but there is no guarantee of it being entirely successful, while lasers have proved to show marginal improvement in the cosmetic appearance of the lesions caused due to this syndrome. Furthermore, laser therapy is considered to be much more effective and safe when compared to the surgical procedures.
1) When does Becker’s nevus stop growing?
Becker’s nevus typically develops during puberty and continues to grow in size and pigmentation till the age of 25 to 30 years.
2) Is a Becker’s nevus hereditary?
No, there is no evidence that support the fact that Becker’s nevus syndrome runs in familiy.
3) How is a Becker’s nevus diagnosed?
It can only be diagnosed through a clinical examination of the affected skin, wherein a small sample of your skin is taken, in a process called biopsy, to examine it under the microscope. It is typically a brown, hairy, deeply-pigmented patch mostly on the shoulder or upper trunk of the body.