Been treating those patches on your cheeks as melasma, but they're just not budging? They might not be melasma at all. Hori's naevus is a lookalike that's especially common in Asian skin, and because its pigment sits deeper, it needs a different treatment plan. Here's how to tell the two apart, and why getting it right makes all the difference.
What is Hori's naevus?
Hori's naevus (also spelt Hori's nevus, and known medically as ABNOM) is a type of pigmentation where pigment-producing cells sit deep in the dermis, the layer beneath the skin's surface. It usually appears on both cheeks, often starting as small brown or grey-brown spots that can merge into larger patches over time.
It tends to show up in adulthood, which is why it's so often mistaken for melasma.
How is it different from melasma?
Melasma happens when pigment cells become overactive and produce extra pigment, often triggered by sun exposure or hormonal changes. Its patches are usually brown and can also affect both cheeks. Melasma pigment can sit near the surface, deeper in the skin, or both.
The difference is what's going on underneath. With Hori's naevus, there are pigment cells in a place they don't usually live. With melasma, normal pigment cells are simply overproducing. Same cheeks, different story.
Hori's naevus vs melasma at a glance
| Hori's naevus | Melasma | |
|---|---|---|
| What's behind it | Pigment cells deep in the dermis | Overactive pigment cells producing extra pigment |
| Colour | Brown spots that may turn grey-brown or slate-grey | Usually brown patches |
| Pattern | Spots or patches on both cheeks | Patches, often on both cheeks |
| Common triggers | Often genetic | Sun exposure and hormonal changes |
What's behind it
- Hori's naevus
- Pigment cells deep in the dermis
- Melasma
- Overactive pigment cells producing extra pigment
Colour
- Hori's naevus
- Brown spots that may turn grey-brown or slate-grey
- Melasma
- Usually brown patches
Pattern
- Hori's naevus
- Spots or patches on both cheeks
- Melasma
- Patches, often on both cheeks
Common triggers
- Hori's naevus
- Often genetic
- Melasma
- Sun exposure and hormonal changes
Because the two overlap in colour and pattern, it's hard to tell them apart in the mirror. Your doctor uses a closer examination to tell the difference.
Can you have both?
Yes, the two can show up together. If your patches have partly improved with melasma care but some areas are hanging on, a mix of the two could be why. In that case, your doctor will plan for both, since treating one doesn't treat the other.
Why the right diagnosis matters
Where the pigment sits shapes which treatment can reach it. Lightening creams aimed at melasma work on surface pigment, so they're unlikely to touch the deeper pigment of Hori's naevus. That's often why people feel stuck.
Your doctor will examine your skin in good light, sometimes using a dermatoscope, a handheld device that magnifies the skin. Together with your history, this helps them work out which condition you have, or whether it's both.
How is Hori's naevus treated?
Pigment lasers are the main treatment for Hori's naevus, as they can target pigment deeper in the skin. Treatment is usually done over a series of sessions spaced apart, with gradual fading along the way.
Some darkening after treatment, called post-inflammatory hyperpigmentation, can happen, especially in Asian skin. Your doctor will choose settings to suit your skin type and talk you through aftercare and sun protection to lower that risk. If melasma is also present, your plan will account for both.
At Reborn, our Quantum Laser can be tailored to target different types and depths of pigmentation, including deeper patches like Hori's naevus. Read more about how we treat pigmentation, or see our guide on how to remove pigmentation.
Frequently asked questions
Can I tell Hori's naevus from melasma at home?
Not reliably. They overlap in colour, pattern and location. A closer examination by your doctor is the way to tell.
Will lightening creams work on Hori's naevus?
They're unlikely to help much, since the pigment sits too deep for creams to reach. Laser treatment is usually needed.
How many laser sessions will I need?
Hori's naevus usually needs a series of sessions, as deeper pigment fades gradually. Your doctor will plan this around your skin and how it responds.
Will Hori's naevus come back after treatment?
Your doctor will talk you through what to expect for your skin. Daily sun protection helps keep your skin tone even, and any new spots can be reviewed if they appear.
Cheek patches that won't fade?
Book a consultation at Reborn Skin Clinic. Our licensed doctors will assess your pigmentation, explain what's behind it and recommend a treatment plan to suit your skin.