Melanocytic nevus corresponding to hyperpigmentation disease, is a common, largely benign, skin condition resulting from a proliferation of pigmented nevus cells. Melanocytic nevus does not usually require treatment unless malignancy is suspected, and in most circumstances removal is performed solely for cosmetic reasons [1]. The major treatment for removal of melanocytic nevus is surgical excision, laser therapy, electrocautery, chemical peel, cryotherapy, etc. [1,2].

The causes of hyperpigmentation are not clearly known, but the occurrence of deficiency fire (虛火) due to lack of kidney yin (腎陰), i.e., yin deficiency with effulgent fire (陰虛火旺) is suggested as a cause [3]. Inflammation related cytokines can stimulate melanocytes and induce pigmentation of the skin [4,5]. The Hominis placenta pharmacopuncture is an effective drug used in the pathogenesis of fire excess from Yin deficiency [6], and has been reported to inhibit pigmentation [7]. The Soyeom pharmacopuncture have the effect of inhibiting inflammatory cytokines [8].

Therefore, it is suggested that Hominis placenta and Soyeom mixed pharmacopuncture (HSP) is synergistic for improving pigmentation, so that they can effectively treat melanocytic nevus. They are applied clinically and present that it can be effective.

A 58 - year - old woman presented with facial pigmentation and was diagnosed with melanocytic nevus (Fig. 1.). She experienced laser treatment once in the past, and recurred after disappearance. The recurrence time was not clear, and the current history and family history of recurrence were not specific. Biopsies were not performed, and layer analysis of pigmentation was carried out using ECOSKIN (Cuvitz Inc.) (Fig. 2.).

Hominis placenta (0.5ml) and Soyeom (0.5ml) mixed pharmacopuncture (1.0ml) was subcutaneously injected in several places of melanocytic nevus. The treatment was performed 21 times, once a week (2014.06.09 – 2014.10.27). One year later, the procedure was repeated twice (2015.06.22, 06.24) (Fig. 3.). Layer analysis of pigmentation was carried out using ECOSKIN (Fig. 4.). One year later (2016.10.10), when she went back to the outpatient clinic, the nevus had disappeared (Fig. 5.). No other treatment was received during the course. The final ECOSKIN test was not performed because the nevus was lost.

The size of Heizhi (黑痣) corresponding to melanocytic nevus varies from small point sizes to fairly large sizes. Therefore, the treatment for eliminating the melanocytic nevus may also vary in size. Various acupuncture treatments for hyperpigmentation disease, including Heizhi corresponding to melanocytic nevus, include body acupuncture, intradermal acupuncture, ear acupuncture, ear acupressure, bloodletting treatment, pharmacopuncture, plum-blossom needle therapy, burning acupuncture therapy, moxibustion and guasha, etc. [9]. But most of the studies related to hyperpigmentation [10–12] and whitening [13–15] are experimental studies in Korean medicine. In addition, studies on melasma [16] and whitening [17] have been conducted on the increase of melanin pigment. There was one case of the removal of melanocytic nevi, but this was the case of removing the lentigo of small point size [18]. No studies have been performed with melanocytic nevus greater than 1 cm in size.

In this case, we could not apply to general acupuncture treatment with a size of 3x3 cm or more, and we took a subcutaneous injection in several places of melanocytic nevus by mixing Hominis placenta and Soyeom reported to be effective for hyperpigmentation. Hominis placenta could play a role not only as a suppressor of melanin synthesis, but also as a regulator of antioxidant genes and might protect the skin against oxidative stress [7]. The Soyeom is composed of heat-clearing and detoxicating medicinal (淸熱解毒藥), which can inhibit inflammatory cytokine through anti-inflammatory effect and reduce pigmentation after inflammation [8,19].

At the time of admission, pigmentation of layers of the melanocytic nevus was 0.6 in the epidermis, 6.3 in the dermis, and 38.6 in the complex. The HSP was applied about 20 times once a week for 5 months. At 1 year after, pigmentation of the melanocytic nevus was distributed in epidermis 2.1, dermis 21.2, complex 15.9. There was a slight decrease in pigmentation after treatment and the procedure was repeated twice. One year later, when she went back to the outpatient clinic, the melanocytic nevus had disappeared. No other treatment was received during the course.

Generalization into one case is difficult, however, it was effective only with the treatment of pharmacopuncture. The HSP procedure for a fairly large size of the melanocytic nevus seems to be effective. However, it was found that about 20 procedures and long-term observation were required.

June 9, 2014 Appearance at the time of admission

ECOSKIN test, June 9, 2014 Appearance at the time of admission

June 22, 2015 Appearance at the time of admission

ECOSKIN test, June 22, 2015 Appearance at the time of admission

October 10, 2016 Appearance at the time of admission