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Year : 2018  |  Volume : 19  |  Issue : 3  |  Page : 290-292

Bilateral nevus of ota with involvement of palate: A rare case report


Department of Dermatology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Date of Web Publication28-Jun-2018

Correspondence Address:
Dr. Mohammad Adil
B-9, Rizvi Apartments, Medical Road, Aligarh - 202 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_97_17

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How to cite this article:
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

How to cite this URL:
Adil M, Amin SS, Raj D, Alam M. Bilateral nevus of ota with involvement of palate: A rare case report. Indian J Paediatr Dermatol [serial online] 2018 [cited 2019 Jul 18];19:290-2. Available from: http://www.ijpd.in/text.asp?2018/19/3/290/217489



Sir,

Nevus of Ota is a dermal melanocytic nevus characterized by blue–black or gray–brown pigmentation of the skin and mucosa in the distribution of the first and second division of the trigeminal nerve.[1] Disease is more often seen in Japan and is rare in India. We present a rare case of bilateral nevus of Ota with oral mucosal involvement.

A 19-year-old female presented to us with bilateral pigmentation of the cheeks since birth. The lesions were asymptomatic and gradually progressed till the age of 10 years and were static since then. There was no growth of hair over the area or any abnormality of vision or hearing. On examination, ill defined, bluish-brown macules with specks of brown–black pigment were found over bilateral cheeks extending upward up to the lower eyelids and downward till the nasolabial folds. The skin was otherwise normal. Bluish pigment was seen on both the sclerae [Figure 1]. The hard palate showed similar bluish macule on the right side [Figure 2]. The rest of the cutaneous, ocular, otoscopic, and systemic examination was normal. Histopathology from the pigmented skin showed normal epidermis and the presence of numerous elongated dendritic dermal melanocytes in the upper dermis. On the basis of clinical and histopathological evidence, a diagnosis of bilateral nevus of Ota with palate involvement was made.
Figure 1: Diffuse bluish-brown macule over both cheeks and pigmentation of the sclerae

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Figure 2: Oral cavity showing pigmentation of the hard palate

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Nevus of Ota or nevus fuscocoeruleus ophthalmomaxillaris was first described in 1939 from Japan. It is more common in Asians and a female preponderance is seen.[2] About 60% patients present at birth and scleral involvement is present in 27% children.[2] The eye, oral and nasal mucosa, tympanic membrane, external auditory canal, and leptomeninges may also show melanocytic lesions. Bilateral involvement is seen in 4% cases and palatal involvement in less than 20% cases.[3] The nevus is classified into 4 types: mild, moderate, severe, and bilateral.[3]

The pathogenesis of nevus of Ota is unclear. The role of genetic factors and hormones has been proposed due to the predominance in Japanese and females, respectively.[2] The disease occurs due to the failure of migration of the melanocytes from the neural crest to the skin during early embryonic life. Hormones or ultraviolet light may be responsible for the activation of these melanocytes and hence the appearance of pigment.[4] The color appears blue due to the depth of the pigment as a result of the Tyndall effect.

Nevus of Ota is associated with open-angle glaucoma and malignant melanoma.[5] The closest differential diagnosis of our case includes Hori's nevus, which occurs later in life and does not involve the mucosae. It can be easily differentiated from melasma and exogenous ochronosis by its age of onset and type of pigmentation. Although asymptomatic, the disease may have a big psychological impact on the patient. Treatment with Q-switched ruby, alexandrite, and Neodymium-doped Yttrium Aluminum Garnet laser have been successful.

Our patient had bilateral nevus of Ota with palatal involvement, an uncommon presentation of the disease in the Indian subcontinent.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lapeere H, Boone B, Schepper SD, Verhaeghe E, Gele MV, Ongenae K, et al. Hypomelanoses and hypermelanoses. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick's Dermatology in General Medicine. 8th ed. New Delhi: McGraw Hill; 2012. p. 804-26.  Back to cited text no. 1
    
2.
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. 2
[PUBMED]    
3.
Sekar S, Kuruvila M, Pai HS. Nevus of ota: A series of 15 cases. Indian J Dermatol Venereol Leprol 2008;74:125-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Shetty SR, Subhas BG, Rao KA, Castellino R. Nevus of ota with buccal mucosal pigmentation: A rare case. Dent Res J (Isfahan) 2011;8:52-5.  Back to cited text no. 4
[PUBMED]    
5.
Rathi SK. Bilateral nevus of ota with oral mucosal involvement. Indian J Dermatol Venereol Leprol 2002;68:104.  Back to cited text no. 5
[PUBMED]  [Full text]  


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