Introduction
It is a common harmless skin disorder characterized by the presence of small, dark brown or black-colored, or skin-colored bumps. It is usually seen on the face around the eyes and cheekbone. It may also be seen on the neck, chest, and back. Some may have less number of isolated lesions, while others may have more than hundreds. It is commonly seen in Africans and runs in families. It is frequently called moles, but they are not actual moles. It generally begins in adolescence, and the number of bumps and their size increases as age progresses. It rarely affects children and is not associated with systemic illness or syndrome.
What Does It Resemble?
The small, skin-colored spots are uniform, round and flat. They are one to five millimeters in size. The bumps may look rougher as time passes. Small flaps that resemble skin tags may occasionally adhere to the lesion. They are known as peduncles. The bumps are benign (noncancerous) growth that does not lead to skin breaks, scaling, or crusting (hard outer layer). About one-fourth of the population with facial lesions have lesions elsewhere.
Who Is Impacted by Dermatosis Papulosa Nigra?
Up to 35% of Africans are affected by this skin condition. Fairer-skinned African Americans are less likely to experience it. Although the exact percentage is unclear, dark-skinned Asians, Filipinos, Vietnamese, and Polynesians may develop dermatosis papulosa nigra. This skin condition appears more in people with Fitzpatrick skin phototypes 4, 5, or 6 (a scale that classifies skin type based on color and response to UV radiation). The males are less likely to be impacted than females.
What Is the Cause for Dermatosis Papulosa Nigra?
The specific cause for dermatosis papulosa nigra is still not yet identified. However, the likelihood of developing it increases with dark skin color. In many instances, it also appears to be inherited.
The head, neck, and upper trunk are the sites where dermatosis papulosa nigra is most common, as they are more exposed to sunlight. Studies suggest that there may be a connection between UV exposure and the development of dermatosis papulosa nigra.
A recent study shows dark-skinned people who use depigmentation creams have a high incidence of dermatosis papulosa nigra due to decreased UV protection because of pigment loss in the skin.
How to Diagnose Dermatosis Papulosa Nigra?
Dermatosis papulosa nigra can be identified clinically and does not require any testing. Dermatologists can quickly diagnose DPN through a clinical examination because of its features and the location of bumps. However, dermoscopy can be used if there is any doubt. It is a non-invasive technique performed with a handheld device called a dermatoscope. It allows physicians to see the layers of the skin which are not visible to the naked eye. Rarely a procedure called biopsy is done to confirm the diagnosis. The biopsy removes a small piece of tissue under local anesthesia in the affected region and is examined under the microscope to confirm the diagnosis.
What Are the Differential Diagnoses of Dermatosis Papulosa Nigra?
The differential diagnosis includes seborrheic keratoses, melanocytic nevi, angiofibroma, acrochordons, verrucae, and some adnexal tumors.
What Are the Treatments for Dermatosis Papulosa Nigra?
Although dermatosis papulosa nigra is not harmful, some people prefer to have the lesions removed for aesthetic reasons. The size and number only lessen with therapy, and the problem worsens with age. People seeking therapy for dermatosis papulosa nigra should carefully consider their expectations and treatment goals. The aim of treatment should be to diminish the appearance of spots rather than eradicate them because it may only be possible to remove them partially.
Most patients with dermatosis papulosa nigra are people of color who are more likely to experience scarring and pigmentation abnormalities (lightening and darling of skin) because of treatment. The resultant appearance of the skin (scarring) may be undesirable as the spots of dermatosis papulosa nigra.
Treatment falls under two categories:
1. Surgical Treatment: The bumps of dermatosis papulosa nigra are removed surgically by the following methods.
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Cryotherapy: The bumps are frozen by extreme cold by using liquid nitrogen. Cells can not withstand extremely cold conditions and die. Cryotherapy is of two types: Internal and external cryotherapy. In dermatosis papulosa nigra, external cryotherapy is used in which a spraying device or cotton swab is used to apply a freezing agent on the bumps. It results in blistering and shedding of frozen skin.
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Curettage: It uses a thin instrument to scrape the damaged skin or bumps.
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Electrodesiccation: It is a small probe-like device that uses heat from the electric current to burn the bumps. The electric current is passed through the electrode, placed near or on the damaged skin. When the electric current is passed, the electrode's tip gets heated and burns the damaged skin.
2. Laser Treatment:
Lasers emit a wavelength of intense light, which, when targeted on damaged skin, will produce heat and destroy the cells. It involves using different frequencies to remove the bumps in dermatosis papulosa nigra.
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Carbon Dioxide Lasers: A recent study found that carbon dioxide lasers are safe to use in this skin condition.
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Neodymium Yag Lasers: The long pulses are used to deliver the laser energy, and these pulses heat the damaged tissue and destroy the cell.
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KTP Laser: In this method, potassium titanyl phosphate (KTP) is used along with Nd: YAG laser to destroy the cells in the bumps. KTP is a laser medium to produce a wavelength of 532 nanometers. This KTP laser targets only the oxyhemoglobin in the blood and thus leaves the surrounding structures and tissues unaffected.
Treatment varies for each individual depending on the severity and spread of the skin condition.
It should be remembered that the treatment might cause scarring in the skin, and it is not assured that the bumps will not recur.
What Is the Prognosis of Dermatosis Papulosa Nigra?
It is a benign, painless skin condition that appears in adolescence and continues to increase in number and size with age. It will not resolve on its own.
Conclusion
A harmless skin condition, dermatosis papulosa nigra that occurs commonly on the face and can be left untreated. Some consider treatment for aesthetic purposes. Though treatment options are many, they may cause scarring of the skin. Consulting a dermatologist is suggested to determine the best treatment option that suits the skin type.
