Hori's naevus: the cheek pigment mistaken for melasma
Medically reviewed by Dr Sin Yong · Last reviewed · 3 min read
Published 13 October 2026 · Reviewed by Dr Sin Yong
Hori's naevus, also called acquired bilateral naevus of Ota-like macules (ABNOM), is acquired dermal melanocytosis: pigment cells lying in the dermis of both cheeks instead of the epidermis, seen as discrete blue-grey or grey-brown speckled macules over both cheekbones. It appears in adulthood, mostly in women of East and Southeast Asian descent, and is routinely mislabelled as melasma or freckles. Because the pigment sits deep, creams do not reach it; treatment relies on dermis-reaching wavelengths such as 1064 nm.
Key facts
What it is
Acquired dermal melanocytosis of both cheeks, described by Hori in 1984
Who
Mostly women of East and Southeast Asian descent, onset in the twenties to forties; a routine presentation in Singapore
Versus melasma
Speckled, discrete, bluish spots that do not darken sharply after sun; melasma is soft, confluent and brown. Eyes and mouth are not involved, which separates it from naevus of Ota
Treatment and risk
Laser wavelengths that reach dermal pigment, such as 1064 nm, in staged conservative visits after melasma is excluded or controlled; post-laser darkening is common
Where Hori's naevus matters on this site
Hori's naevus is a routine presentation in Singapore and a routine misdiagnosis, so it is referred to across the melasma, pigmentation and laser pages as the depth question they all have to answer.
Grey under the cheekbone that has ignored every cream is usually telling you its depth, not its stubbornness.— Dr Sin Yong
Hori's naevus (ABNOM): the condition page, with the Wood's lamp and dermatoscope findings and the treatment caveats.
Sun spots: the epidermal spots that often share the same cheek.
The practical message on every page is the same: creams act on the epidermis, Hori's pigment sits in the dermis, and long use of lightening agents cannot bridge that gap.
Not to be confused with
Depth is what separates Hori's naevus from its lookalikes, and the Wood's lamp and the dermatoscope are how depth is read at the bedside.
Hori's naevus itself: discrete blue-grey or grey-brown speckled macules over both cheekbones, appearing in adulthood. Dermal pigment is poorly accentuated under Wood's light and shows a diffuse blue-grey pattern under the dermatoscope, with no network.
Melasma: soft, confluent, brown patches that darken sharply after sun. Epidermal pigment is enhanced under Wood's light and shows a brown reticular pattern under the dermatoscope. The two often coexist, and the melasma is controlled first because laser heat can flare it.
Naevus of Ota: present from birth or childhood, usually on one side, and involving the white of the eye and the temple. Hori's spares the eyes and mouth and is bilateral.
Solar lentigines and freckles: discrete, sharply bordered, brown and epidermal, with a network or fingerprint pattern.
Periorbital hyperpigmentation: darkness around the eyes rather than over the cheekbones, with its own set of causes.
Several browns on one face are the norm rather than the exception, and Dr Sin Yong names each at one examination before any wavelength is chosen.
Where it fits
Depth, not colour alone, decides whether a cream or a laser can reach a pigment. Lightening agents act on epidermal pigment production, and Hori's pigment sits in the dermis beneath their reach, which is why years of creams prescribed for 'melasma' change nothing. Hori's naevus often coexists with melasma, solar lentigines or freckles on the same face, so Dr Sin Yong sorts the browns at one examination and treats the melasma component first, because laser heat can flare it. Full page: Hori's naevus (ABNOM); the condition it is confused with on melasma treatment; the sorting guide on types of facial pigmentation.
Frequently Asked Questions
Not the Hori’s pigment itself. Lightening creams act on pigment production in the epidermis, and tranexamic acid is a melasma treatment; Hori’s pigment is cells sitting in the dermis, beneath the reach of both. Where melasma coexists, those treatments address the melasma component, which is controlled first; the dermal spots are a laser question, planned separately.
Post-inflammatory hyperpigmentation after laser is common in this condition, particularly in Fitzpatrick III to V skin, because the energy needed to reach dermal pigment also provokes the epidermis. It is one reason treatment is staged and conservative, melasma is controlled beforehand, and sun protection is strict. Darkening is planned for and reviewed rather than treated as a surprise.
No. Melasma is epidermal and dermal pigment production in soft, confluent brown patches that flare with sun and heat. Hori's naevus is pigment cells sitting in the dermis, seen as discrete blue-grey speckles over both cheekbones. The two often coexist, and each needs its own plan.
Because they act on pigment production in the epidermis, and this pigment sits in the dermis beneath their reach. Treatment relies on laser wavelengths that penetrate to the dermis, delivered conservatively because darkening after laser is common in this condition.
References
Chan JC, Shek SY, Kono T, Yeung CK, Chan HH. A retrospective analysis on the management of pigmented lesions using a picosecond 755-nm alexandrite laser in Asians. Lasers Surg Med. 2016;48(1):23-29. doi:10.1002/lsm.22443. source
