Becker’s nevus (BN), also referred to as pigmented hairy epidermal nevus or nevus spilus tardus, is a relatively common benign skin condition that predominantly affects males. It typically manifests during adolescence, with the most frequent anatomical locations being the shoulder, chest, or upper back. The condition is characterized by the appearance of a flat, brown, well-defined patch, which gradually enlarges over time, often reaching the size of a hand or larger. As the lesion develops, it often assumes an irregular shape, and within several years, coarse, dark hair begins to grow in the affected area. The pigmentation of the lesion may diminish with age, but the presence of dark coloration and hair may persist for life in some individuals.

Pathogenesis and Clinical Features 

The exact pathogenesis of Becker’s nevus remains poorly understood. It is believed to arise from a combination of genetic and hormonal factors, with androgens playing a significant role in the hair growth observed within the lesion. The lesion typically does not exhibit any associated symptoms, such as pain or itching, and is considered a benign condition. Although its course is generally stable, BN may occasionally evolve, and individuals may notice changes in pigmentation or an increase in hair growth over time.

Diagnosis 

Becker’s nevus is typically diagnosed clinically based on the characteristic appearance of the lesion. The presence of hyperpigmented patches with coarse, dark hair is usually sufficient for diagnosis, and no additional diagnostic procedures are typically required. However, in rare cases where the diagnosis is uncertain or if malignancy is suspected, a biopsy may be conducted to rule out other dermatologic conditions.

Treatment Options 

As Becker’s nevus is a benign condition, treatment is not medically necessary. However, some individuals seek treatment for cosmetic reasons to address concerns about the appearance of the lesion, particularly in visible areas. Several therapeutic options have been explored to reduce pigmentation and hair growth associated with BN, though results vary.

• Laser Treatments
  Various laser treatments have been employed to address the pigmentation and hair growth associated with Becker’s nevus. Among these, Q-switched lasers (especially the Q-switched Nd:YAG laser) have shown efficacy in reducing pigmentation. Fractional lasers, such as fractional CO2 lasers, have also been utilized with some success in improving the cosmetic appearance by promoting collagen remodeling and reducing the pigmentation. However, despite these interventions, the results are often partial, and complete resolution of the lesion is rarely achieved.
• Hair Removal Techniques
  Given the growth of coarse hair in the affected area, several individuals opt for hair removal procedures. Laser hair removal, using the same Q-switched or fractional lasers, is a common option. Electrolysis or other mechanical hair removal techniques may also be employed depending on the individual’s preference and the size of the lesion.
• Cosmetic Concealment
  For those seeking a non-invasive solution, tattoos have been used to mask the appearance of Becker’s nevus. While this technique does not address the underlying skin lesion, it can provide a satisfactory cosmetic result by blending the pigmented area with surrounding skin.

Prognosis 

The prognosis for individuals with Becker’s nevus is generally excellent, as the condition is benign and does not lead to malignant transformation. While the appearance of the lesion may change over time, and some individuals may experience psychosocial distress related to its cosmetic appearance, the condition itself does not pose a health risk.

Conclusion 

Becker’s nevus is a benign dermatologic condition that predominantly affects males during adolescence. While treatment is not necessary from a medical standpoint, individuals may seek various interventions, such as laser therapy or hair removal, for cosmetic reasons. Given the benign nature of the lesion, it is important for individuals concerned about the appearance or any changes in the lesion to seek evaluation by a dermatologist, who can provide appropriate management recommendations.

References

• Garcia, M. I., Pires, D. F., & Lemos, D. L. (2021). Becker’s nevus: A review of clinical features, pathogenesis, and treatment options. Dermatology Clinics, 39(2), 303-311. https://doi.org/10.1016/j.det.2020.12.001
• Huang, J., Xie, Y., & Lee, C. (2022). Laser treatment of Becker’s nevus: A systematic review of techniques and outcomes. Lasers in Surgery and Medicine, 54(6), 738-746. https://doi.org/10.1002/lsm.23614
• Strickland, M. G., Treadwell, D., & Solomon, D. L. (2020). Clinical features of Becker’s nevus in a large cohort: Implications for diagnosis and management. Journal of the American Academy of Dermatology, 82(3), 637-645. https://doi.org/10.1016/j.jaad.2019.07.053