eMedicine Specialties > Dermatology > Benign Neoplasms

Dermatosis Papulosa Nigra

Mehran Nowfar-Rad, MD,, Assistant Clinical Professor, Division of Dermatology, David Geffen School of Medicine University California at Los Angeles; Consulting Physician, Division of Dermatology, Olive View Medical Center
Frederick Fish, MD, Director, Department of Dermatology and Cutaneous Surgery, St Paul Ramsey Medical Center; Associate Clinical Professor, Department of Dermatology, University of Minnesota

Updated: Feb 19, 2009

Introduction

Background

Dermatosis papulosa nigra (DPN) is a benign cutaneous condition common among blacks. It is usually characterized by multiple, small, hyperpigmented, asymptomatic papules on the face of adult blacks. Histologically, dermatosis papulosa nigra resembles seborrheic keratoses. The condition may be cosmetically undesirable to some patients.

Pathophysiology

The pathophysiology of dermatosis papulosa nigra is not known. The occasional positive family history may suggest a genetic propensity.

Frequency

United States

Whereas earlier studies revealed a 10% frequency in adult blacks, more recent data suggest a frequency of approximately 35% in this population.

International

Data pertaining to the international frequency of dermatosis papulosa nigra are insufficient.

Mortality/Morbidity

Dermatosis papulosa nigra is not associated with any mortality or morbidity.

Race

Dermatosis papulosa nigra affects up to 35% of the African American population.¹ Blacks with a fair complexion have the lowest frequency of involvement.² Dermatosis papulosa nigra also occurs among Asians, although the exact incidence is unknown.

Sex

Females are affected more frequently than males.²

Age

Dermatosis papulosa nigra usually begins in adolescence and is rare in persons younger than 7 years.³ The incidence of dermatosis papulosa nigra, as well as the number and size of individual lesions, increases with age.

Clinical

History

Lesions usually begin during puberty. They tend to increase steadily in number and size as the individual ages.

Physical

Dermatosis papulosa nigra is characterized by multiple, firm, smooth, dark brown to black, flattened papules that measure 1-5 mm in diameter. Lesions occur mainly on the malar area of the face and the forehead, although they also may be found on the neck, upper back, and chest. A small percentage of patients have similar lesions on the upper trunk. Scaling, crusting, and ulceration do not occur.

Causes

Dermatosis papulosa nigra is likely to be genetically determined, with 40-54% of patients having a family history of involvement. Dermatosis papulosa nigra is believed to be caused by a nevoid developmental defect of the pilosebaceous follicle. Hairston et al have suggested that dermatosis papulosa nigra should be classified within the group of epithelial nevi.⁴

Differential Diagnoses

Nevi, Melanocytic
Seborrheic Keratosis

Workup

Histologic Findings

Lesions of dermatosis papulosa nigra have the histologic appearance of seborrheic keratoses; they display hyperkeratosis, irregular acanthosis, keratin-filled invaginations of the epidermis (horn cysts), and marked hyperpigmentation of the basal layer. Although most lesions are of the acanthotic type and show thick interwoven tracts of epidermal cells, they may have a reticulated pattern in which the tracts consist of a double row of basaloid cells.

Treatment

Surgical Care

No treatment generally is indicated for dermatosis papulosa nigra unless lesions are cosmetically undesirable. Aggressive therapeutic modalities have been complicated by postoperative hyperpigmentation or hypopigmentation or scarring. Keloid formation is a potential complication. Therefore, conservative treatment is advisable.

Abrasive curettage with or without anesthesia,⁵ superficial liquid nitrogen cryotherapy, and electrodesiccation followed by curettage have been shown to be effective. Laser therapy has also been reported.⁶ Both EMLA (topical lidocaine/prilocaine cream) and LMX (topical lidocaine cream) creams are effective for providing topical anesthesia.⁷ Use caution with all therapies to minimize the depth of treatment.

Follow-up

Prognosis

The prognosis for patients with dermatosis papulosa nigra is excellent since it is not a premalignant condition nor is it associated with any underlying systemic disease. However, lesions of dermatosis papulosa nigra show no tendency to regress spontaneously, and they gradually may increase in number and size with age.

Miscellaneous

Medicolegal Pitfalls

Dermatosis papulosa nigra is generally a clinical diagnosis and is only rarely confused with melanocytic lesions. A skin biopsy would be helpful in such cases.

References

Dunwell P, Rose A. Study of the skin disease spectrum occurring in an Afro-Caribbean population. Int J Dermatol. Apr 2003;42(4):287-9. [Medline].
Grimes PE, Arora S, Minus HR, Kenney JA Jr. Dermatosis papulosa nigra. Cutis. Oct 1983;32(4):385-6, 392. [Medline].
Babapour R, Leach J, Levy H. Dermatosis papulosa nigra in a young child. Pediatr Dermatol. Dec 1993;10(4):356-8. [Medline].
Hairston MA Jr, Reed RJ, Derbes VJ. Dermatosis papulosa nigra. Arch Dermatol. May 1964;89:655-8. [Medline].
Kauh YC, McDonald JW, Rapaport JA, Ruschak PJ, Luscombe HA. A surgical approach for dermatosis papulosa nigra. Int J Dermatol. Dec 1983;22(10):590-2. [Medline].
Schweiger ES, Kwasniak L, Aires DJ. Treatment of dermatosis papulosa nigra with a 1064 nm Nd:YAG laser: report of two cases. J Cosmet Laser Ther. Jun 2008;10(2):120-2. [Medline].
Carter EL, Coppola CA, Barsanti FA. A randomized, double-blind comparison of two topical anesthetic formulations prior to electrodesiccation of dermatosis papulosa nigra. Dermatol Surg. Jan 2006;32(1):1-6. [Medline].
Andrews GC, et al. Andrews' Diseases of the Skin. 8^th ed. Philadelphia, Pa: WB Saunders; 1990:752.
Elder D, et al. Lever's Histopathology of the Skin. 8^th ed. Philadelphia, Pa: Lippincott-Raven; 1997:693.
Moschella SL, Hurley HJ. Dermatology. Philadelphia, Pa: WB Saunders; 1992:2162-3.
Rook A, Wilkinson DS, Ebling FJG. Textbook of Dermatology. Vol 2. Oxford, England: Blackwell Scientific; 1998:1660-1.

Keywords

dermatosis papulosa nigra, DPN, hyperpigmented papules, facial papules, seborrheic keratosis

Contributor Information and Disclosures

Author

Mehran Nowfar-Rad, MD,, Assistant Clinical Professor, Division of Dermatology, David Geffen School of Medicine University California at Los Angeles; Consulting Physician, Division of Dermatology, Olive View Medical Center
Mehran Nowfar-Rad, MD, is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

Coauthor(s)

Frederick Fish, MD, Director, Department of Dermatology and Cutaneous Surgery, St Paul Ramsey Medical Center; Associate Clinical Professor, Department of Dermatology, University of Minnesota
Frederick Fish, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physicians, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Dermatopathology, Pacific Dermatologic Association, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Kathryn Schwarzenberger, MD, Associate Professor of Medicine, Division of Dermatology, University of Vermont College of Medicine; Consulting Staff, Division of Dermatology, Fletcher Allen Health Care
Kathryn Schwarzenberger, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, American Dermatological Association, Dermatology Foundation, Medical Dermatology Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Further Reading