By Gary M. White, MD
The Becker's nevus (BN) is a hyperpigmented and hypertrichotic area that usually develops in adolescence.
- Onset may be congenital or up to 17 years of age.
- The condition is most common in boys on the trunk.
- The Becker's nevus is typically brown with a variable amount of hypertrichosis.
- There may be soft tissue atrophy (e.g. breast) or rarely hypertrophy.
- Lesions overlying the chest in girls may cause breast hypoplasia.
- Ipsilateral hypoplasia of the shoulder girdle and an ipsilateral absence of the pectoralis major muscle have also been seen, as well as ipsilateral skeletal defects (rare).
- Lipoatrophy may be seen and is more common in women.
- Skin conditions reported to occur that are restricted to the area of a BN include acne and granuloma annulare.
- BN and congenital smooth muscle hamartoma are thought to be variants of the same hamartomatous process.
A congenital or early onset area of hyperpigmentation and/or hypertrichosis is seen. The upper trunk and/or proximal upper arms in a male is the most common presentation. A fine dermal papular component may occasionally seen and represents hyperplasia of smooth muscle bundles.
Usually no treatment is performed. There has been some success reported with lasers [J Cutan Aesthet Surg. 2009;2:72-80]. For excessive hair, laser hair removal may be considered. Topical flutamide reduced the hypertrichosis in one woman [JAAD Volume 2013;69; e147–e148]. Spironolactone increased breast size in one case of breast hypoplasia.
Becker's melanosis before and after CO2 laser. J Cutan Aesthet Surg. 2009 Jul-Dec;2(2):72-80
Topical Flutamide reduced the hypertrichosis for a 22-year-old woman. JAAD Volume 69, Issue 3, Pages e147–e148, September 2013
Breast hypoplasia from Becker's nevus. J Am Acad Dermatology Courtesy of Dr László Török, Kecskemét, Hungary.
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