Follicular Becker's Nevus: Clinical, Dermoscopic and Histopathological Description of Two Cases and Literature Review

Follicular Becker's nevus (FBN) is a rare variant of Becker's nevus defined by perifollicular pigmentation and folliculocentric distribution. We report two new cases in Caucasian women, aged 22 and 37, with lesions on the breast and lumbar regions. Both presented progressive, asymptomatic hyperpigmented macules since adolescence. Dermoscopy revealed donut-shaped perifollicular structures with hypopigmented halos surrounded by a reticulated brown network, while histopathology confirmed orthohyperkeratosis, basal pigmentation, elongated rete ridges, and hypertrophic arrector pili muscle bundles. In addition, we reviewed all published FBN cases, highlighting its distinct folliculocentric pattern, predilection for non-scapular sites, and occurrence beyond Asian cohorts. Both of our patients showed favorable outcomes with picosecond laser therapy, suggesting this approach as a promising treatment option.