Nevus of Hori in African patients: an entity that is most likely underdiagnosed in clinical practice.

Background: Nevus of Hori (HN) has been primarily reported in patients of Eastern Asian descent, with a paucity of data regarding HN occurring in African patients. In this study, we report on South African patients with HN initially thought to have melasma.

Objective: To characterize the histopathological and clinical phenotypes of HN in African patients.

Methods: Retrospective data were collected from patients who met the inclusion criteria. These data entailed the clinical distribution, demographic data, Fitzpatrick skin phototype, and histopathologic features of African patients diagnosed with HN from a single private aesthetic center in Bloemfontein, South Africa.

Results: Thirty patients with an average age of 49 ± 7.37 were included in this analysis. The majority of patients were female (n = 29; 96.67%), and most patients were of Fitzpatrick skin phototype V (n = 22; 73.3%). The most common clinical distribution pattern was bitemporal (76.7%), followed by the zygomatic pattern (20%), mixed type (16.7%), and finally the central forehead pattern (3.3%). Histopathologically, the dendritic cell type of melanocytes was observed in the majority of patients (n = 25; 83.3%), while spindle-shaped cells were observed in few patients (n = 7; 23.33%), and none of the patients had bipolar-type melanocytes.

Limitations: This study has limitations inherent to small sample size and its inability to accurately generalize the findings.

Conclusion: HN can clinically mimic melasma in African patients. The most common clinical presentation was bitemporal. To our knowledge, this study is the largest regarding the clinicopathological profile of HN in African patients and it is likely to be the first to report these compelling findings.