It is common to see adults of color with multiple small hyperpigmented dots on the face that resemble raised dark brown or black freckles. More than likely they are what is called dermatosis papulosa nigra (DPN). They are often referred to as moles, and at times resemble mole-like bumps, but they are not moles; they are non-cancerous lesions.
What is Dermatosis Papulosa Nigra?
Dermatosis papulosa nigra is a form of seborrheic keratosis, the most common noncancerous skin growth in older adults. It manifests in brown or black dots that resemble moles.
These flat or raised papules can measure between 1-5 mm in diameter and occur mainly on the cheeks and forehead. They can also develop around the eye area, on the neck, chest, and upper back.
Dermatosis papulosa nigra is common among those of African descent and affects many Black people in the United States. The occurrence is less frequent among those with lighter skin. DPN also occurs among Asians, Polynesians, and Latin and Native Americans with darker skin tones. The condition more commonly manifests in women.
Causes of DPN
The cause of DPN is still unknown. It is believed to be a congenital anomaly of the skin caused by a developmental defect of the hair follicle. Some medical professionals speculate that it is due to photoaging while other researchers believe it is a combination of sun exposure and heredity. Around 50% of patients seeking treatment have a family history of the skin condition—a parent or grandparent, for example, might have them. Formation typically begins during teen years, and they may increase in number and size as one ages.
DPN doesn’t require treatment. While these are benign growths, if you are not sure that a lesion that has developed is dermatosis papulosa nigra, you should check with a dermatologist to make sure it isn’t a serious or cancerous growth. DPN doesn’t usually cause pain or discomfort unless the lesion becomes irritated by rubbing against or catching on clothing, for example, or becomes inflamed. But the lesions also don’t go away on their own. Many medical professionals believe they are best left alone, but some individuals who don’t like their appearance choose to seek treatment. Just be aware that at times removal can lead to hyperpigmentation (darkening of the skin), hypopigmentation (lightening of the skin), scarring, or keloid formation.
Methods for Removal
There are more cosmetic procedures that are effective and safer for skin of color than in the past. Since these treatments are cosmetic, they are usually not covered by health insurance.
Curettage (scraping) uses a curette, an instrument for scraping away growths. There is a risk of pigmentation problems in darker skin.
There are two methods that use electric current to destroy and remove DPN: electrocautery and electrodesiccation. With electrocautery (or thermal cautery), electric current runs through a small probe with a fine needle electrode tip to cauterize (burn or destroy) skin tissue. In electrocautery the tip becomes hot, but the current doesn’t pass through the patient.
Electrodesiccation is a specific type of electrosurgery (also called fulguration) and dehydrates and destroys superficial tissue. The electrode remains cool and the electrical current passes through the tissue. Without touching the surrounding skin, the lesions are desiccated using an instrument with an electrical needle-like tip until the lesions turn a grayish color. An application of a topical anesthetic prior to the procedure will make it more comfortable. Depending on the size of the lesion, electrodesiccation treatments might be followed with curettage, or some raised lesions may need to be snipped with special scissors. At low settings, these are considered safe and effective procedures with minimal to no scarring.
After treatment lesions will be red and swollen (like an insect bite) for an hour or so. An antibiotic ointment is applied to soothe the skin. The treated skin will scab and fall off within seven to 10 days. Lesions don’t grow back, but new ones may develop.
DPN can also be treated using cryotherapy (freezing) using liquid nitrogen, but there is a possibility of discoloration and scarring and the risk of post-inflammatory hyperpigmentation, that makes it a potentially less appealing option.
Lasers are the most expensive treatment and create a scab that falls off a few days later. The Nd:YAG laser has a wavelength (1064nm) that is safe for dark skin. It coagulates melanin in the dark spots and blood vessel supply to the growths. There is a little pain but minimal side effects. The skin heals within one week. There is a possibility of skin discoloration, but it will fade if it does happen. Sometimes a lightening agent is used to speed up fading.
After any treatment, refrain from picking at lesions and avoid sun exposure. Do not use any anti-aging products, alpha hydroxy acids, or any other products that have ingredients that are abrasive and can potentially cause irritation, skin sensitivity, or photosensitivity. Apply sunscreen whenever you will be exposed to sunlight. If the face and cheeks have been treated, do not apply makeup, including blush, to the area for three to four days after treatment.
Natural and Home Treatments for DPN
No creams or ointments have been developed to safely treat and remove DPN.
As for natural treatments, there are a few to be found on the internet, however it's best to use common sense when it comes to home remedies and not cause further damage to the skin. If you don’t already see a dermatologist, check around and get referrals from medical professionals that are experienced with skin of color and specifically skilled with treating skin conditions.
Tran M, Richer V. Elective Treatment of Dermatosis Papulosa Nigra: A Review of Treatment Modalities. Skin Therapy Lett. 2020;25(4):1-5.
Uwakwe LN, Souza B, Subash J, McMichael AJ. Dermatosis Papulosa Nigra: A Quality of Life Survey Study. J Clin Aesthet Dermatol. 2020 Feb;13(2):17-19
Uwakwe LN, Souza B, Subash J, McMichael AJ. Dermatosis papulosa nigra: a quality of life survey study. J Clin Aesthet Dermatol. 2020;13(2):17-19.
Vashi NA, Kundu RV. Facial hyperpigmentation: causes and treatment. Br J Dermatol. 2013;169 Suppl 3:41-56. doi:10.1111/bjd.12536
Tran M, Richer V. Elective treatment of dermatosis papulosa nigra: a review of treatment modalities. Skin Therapy Lett. 2020;25(4):1-5.