Facial melanosis is a group of heterogeneous entities, sharing a common clinical feature of altered pigmentation of the face and thus easily visible cosmetic disfigurement and significant psychosocial consequences.

Facial and neck pigmentations are common in middle-aged women, and  Caused by –

1. Endogenous factors i.e. hormones or nutritional deficiency.
2. Exogenous factors – such as use of cosmetics and perfumes, and exposure to sun radiation or pollution.

Various causes of facial melanosis are

1. Melasma.
2. Post-inflammatory hyperpigmentation i.e. pigmentation left after healing of injury, cuts, wounds or skin disease.
3. Drug-induced hyperpigmentation i.e. due to allergy to some medicines.
4. Various skin disease specific pigmentation such as Lichen Planus Pigmentosus and Erythema dyschromicum perstans Riehl’s melanosis, poikiloderma of Civatte and so on.
5. Cosmetic hyperpigmentations such as perfumes, fragrances in cosmetic products can cause pigmentation on facial skin.

Melanosis tend to have a prolonged course and, in many cases, are refractory to treatment,

A range of treatment modalities are

1. Removal of or correcting the factors causing pigmentation.
2. Vigorous photoprotection, and some form of.
3. depigmenting agents – such as
   • Topical hydroquinone 2 to 4% alone or in combination with tretinoin 0.05- 0.1%,
   •  Topical azelaic acid 15 to 20%,
   •  Kojic acid, alone or in combination with glycolic acid or hydroquinone, and
     topical retinoids, and
   •  various other cosmoceuticals.
4. chemical peels such as azelaic acid, kojic acid, and glycolic acid peels.
5. Q-switched lasers and Picco lasers.

The above mentioned treatment modalities, when used alone or in combinations, are effective in improving melanosis but some of the conditions especially melasma can recur and may require continuation of topical skin lightening agents in conjunction with rigorous sun protection.

The nevus of Ota is a distinctive, congenital, benign, bluish grey pigmented lesion, which usually occurs on one side of face, affecting particularly the skin of eyelids, the cheeks, forehead, scalp, nose and ears. It also involves sclera (white visible part of eye) and conjunctiva. It may appear at birth or at early childhood and slowly increases in size till puberty. Rarely does it appear on both sides of face. It was first described by Ota in 1939. The condition is uncommon in India. It is very rare in male patients.

The main problem is usually cosmetic but different complications may appear. Glaucoma (increase in eye pressure associated with headache) appears in approximately 10% of patients. The most serious but unusual complication is the development of malignant melanoma on pigmented areas.

Nevus of OTA can be effectively treated with Q-switched Nd:YAG laser. Treatment is given once in 6-12 weeks and it may take anything between 8-12 treatment sessions to achieve 80%-95% reduction in skin pigment. Pigment in eyes (sclera) cannot be reduced by any means