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What will the patient tell you? (History)
What will the patient tell you? (History)
Dermatosis Papulosa Nigra is a benign epidermal growth considered a variant of seborrhoeic keratosis. It presents as multiple small, hyperpigmented papules and is predominantly seen in people with darker skin tones (Fitzpatrick III–VI).
Patients usually report the gradual appearance of small, dark bumps that begin in adolescence and increase in number and size with age, becoming more noticeable in their 3rd to 6th decade.
Symptoms:
The lesions are typically asymptomatic. Occasionally, patients may report irritation from friction (e.g., shaving, jewellery, clothing).
Main Concern:
The primary reason for seeking care is cosmetic concern and the impact on self-esteem.
Risk Factors:
A strong genetic component is common, with 40–90% of patients reporting a positive family history. The condition is common in individuals of African, Afro-Caribbean, Asian, and other darker-pigmented descent.
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Image Sourced From Skin Sight
What will it look like? (Examination)
DPN presents as multiple, smooth, firm papules that are dark brown to black in colour.
Appearance:
Size: Approximately 1–5 mm in diameter.
Shape: Dome-shaped, sessile, or filiform (stalk-like).
Surface: Typically smooth without scaling or crusting.
Distribution: Lesions are predominantly found on the face (cheeks, temples, periorbital areas), neck, upper chest, upper back, and shoulders, often in a symmetric pattern.
Crucial Note for Darker Skin Tones:
The lesions are especially conspicuous against the background skin tone, making them a significant cosmetic concern. Diagnosis is primarily clinical, but dermoscopy can show features similar to seborrhoeic keratosis (cerebriform fissures/ridges).
Biopsy is reserved for atypical lesions to rule out malignancy.
How can you help? (Treatment)
The key principle is reassurance—DPN is benign and does not become cancerous. Treatment is not medically necessary and is primarily cosmetic. Interventions must be conservative due to the high risk of pigmentary changes and scarring in darker skin tones.
Counselling and General Measures:
Reassure the patient that the lesions are non-cancerous.
Crucially, discuss the risk of post-inflammatory hyperpigmentation (PIH), hypopigmentation, and keloid/hypertrophic scarring, which can be worse than the original condition.
Test a small area first before proceeding with larger-scale removal.
Advise strict sun protection to reduce the risk of PIH post-procedure.
Procedural Options (Must be superficial and conservative):
Light Electrodesiccation: Use a low-power setting to conservatively destroy the lesion.
Snip Excision/Light Curettage: Effective for removing raised lesions while maintaining minimal depth to reduce scarring.
Laser Therapy: Various lasers (e.g., Nd:YAG, CO₂) can be used for multiple lesions, often requiring multiple, gentle sessions.
Caution: Cryotherapy (liquid nitrogen) and aggressive treatments (deep electrodesiccation, aggressive curettage) should be used with extreme caution or avoided in darker skin tones due to the very high risk of permanent hypopigmentation and scarring.
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