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Acquired bilateral nevus of Ota-like macules (ABNLM), also called nevus fuscoceruleus zygomaticus or nevus of Hori, is a relatively common disease in Asia. It is refractory to all medical treatment.To present the first report on the use of Q-switched ruby laser to treat ABNLM.One hundred and forty female patients, ages 19–62 years (mean 39 years), were included in the study. The laser fluence employed was 7–10 J/cm2, at a repetition rate of 1 Hz, and with a spot size of 2–4 mm. The number of treatment sessions ranged from 1 to 6 (mean 2.3).Nine patients were lost to follow-up before complete clearance of the lesions, while in the remaining 131 patients complete clearance was obtained. The only complication was a long-term hypopigmentation, observed in three patients. There was no recurrence at 6 months− 4.3 years (mean 2.5 years) of follow-up.Q-switched ruby laser is an effective and less invasive tool to eradicate ABNLM.