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Dermatosis papulosa nigra (DPN) affects about 35 percent of African Americans but also occurs in other dark-skinned groups such as Asians and Polynesians. DPN appears as multiple small (1-5 mm) smooth black or brown papules on the face and neck. The spots are not cancerous but may be cosmetically undesirable.
DPN begins in adolescents and as the person ages the lesions typically increase in number and size. The papules are most common on the cheeks and forehead but may also occur in the neck, upper back and chest.
They appear simply as darkened spots on the skin and do not bleed or crust over. Women are more affected than men and 40 to 50 percent of those with DPN have a family history of them.
Treatment
While treatment is not required for DNP some people desire to have them removed, especially if on the face. A doctor may send off a biopsy if there is any doubt what the lesions are but the histology usually comes back similar to another skin condition called seborrhoeic keratosis.
There is some risk in treating DNP. It is possible to create more scarring, cause more hypo- or hyper-pigmentation areas and even cause keloid formation.
Make sure to seek the care of an experienced dermatologist who has worked with people of color if you seek care for DPN.
Go to the American Academy of Dermatology to their dermatologist search screen below. Select “skin of color” for the specialty and put in your zip code. http://www.aad.org/find-a-derm/
Possible removal options:
--Curettage involves the use of a spoon-like instrument that scrapes the skin lesion to remove it from the skin. In dark-skinned individuals there is always a risk of developing a larger scar where the papule was removed.
--Electrodessication involves the use of electric current that destroys the tissue. According to Realself.com, electrodessication can be very effective in removing DNP lesions if used with a low setting. Patients should avoid picking the areas afterwards to avoid the risk of discoloration.
--Cryotherapy is when liquid nitrogen (the most common solution used) is applied to freeze off a lesion from the skin. “Cryotherapy can be used but there is a risk of post-inflammatory hyper-pigmentation” according to Arnold R. Oppenheim, MD. a dermatologist from realself.com.
--Nd: Yag Laser: Laser treatment has historically not been used often on dark-skinned individuals, as lasers tend to stimulate more melanin production causing more skin darkening instead of lightening. Recent advances in laser technology have increased their use in ethnic skin.
Lasers that utilize longer wavelengths and lower power levels have been found to be successfully used on dark-skinned individuals so they are now an option for removal of DPN and other skin lesions.
Dr. Mary Lupo from Realself.com expressed that she found the risk of pigment disruption of the skin is the least using a “532 nm laser with a very small 1mm or less spot size for precise delivery of the energy”.
Source:
Dermatosis papulosa nigra. DermNet NZ. Web 19, Feb. 2012.
http://dermnetnz.org/lesions/dermatosis-papulosa-nigra.html
Curettage and cautery. DermNet NZ. Web 19, Feb. 2012.
http://dermnetnz.org/procedures/curettage.html
Best Treatment for Dermatosis Papulosa Nigra (DPN)? Real Self.com. Web 19, Feb. 2012.
http://www.realself.com/question/liquid-nitrogen-remove-dpn-medicines-dp...
Cryotherapy. DermNet NZ. Web 19, Feb. 2012.
http://dermnetnz.org/procedures/cryotherapy.html
Laser Surgery in Dark Skin. Medscape Nurses News. Web 19, Feb. 2012.
http://www.medscape.com/viewarticle/451058
Michele is an R.N. freelance writer with a special interest in woman’s healthcare and quality of care issues. Other articles by Michele are at www.helium.com/users/487540/show_articles
Edited by Jody Smith
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