What are the other Names for this Condition? (Also known as/Synonyms)

• DPN (Dermatosis Papulosa Nigra)

What is Dermatosis Papulosa Nigra? (Definition/Background Information)

• Dermatosis Papulosa Nigra (DPN) is a benign skin condition that is characterized by the presence of multiple small asymptomatic black-to-brown papules (irregularly-shaped raised skin spots), usually on the face and neck region
• It is a relatively common condition typically seen in individuals with darker skin. The manifestation of Dermatosis Papulosa Nigra sometimes occurs during adolescence and the condition grows in severity with age (increase in size and number of spots)
• The exact cause and risk factors for Dermatosis Papulosa Nigra are not well-established. However, in about half of the recorded cases, the condition is observed to run in families. Some research scientists consider DPN to be a subtype of seborrheic keratosis
• Dermatosis Papulosa Nigra can lead to severe emotional stress in some, due to the cosmetic issues it presents. In such individuals, the healthcare provider may recommend the treatment of DPN through modalities such as laser therapy, electrodessication, or snip surgery
• In a majority of cases, treatment may not be necessary, since no complications are generally associated with Dermatosis Papulosa Nigra. The prognosis of DPN is excellent, but it may cause some cosmetic concerns

Who gets Dermatosis Papulosa Nigra? (Age and Sex Distribution)

• The onset of Dermatosis Papulosa Nigra development can occur during the adolescent stage (age 11years and over); it is very rare to see it in children below this age
• As the individual grows older, the severity of the skin condition increases, meaning that a greater number of papules begin to appear into adulthood
• Both males and females are affected, although a female predominance is noted (2:1 female-male ratio)
• Worldwide, individuals of all racial and ethnic background may be affected. Nevertheless, individuals with darker skin are at a greater risk for DPN
• It is estimated that many Africans (including nearly a third of the African Americans), Asians, Polynesians, and dark-skinned Latinos are affected by this condition

What are the Risk Factors for Dermatosis Papulosa Nigra? (Predisposing Factors)

Currently, no clear risk factors have been identified for Dermatosis Papulosa Nigra (DPN).

• More number of DPN cases is reported from dark-skinned individuals than fair-skinned individuals; thus, the condition is more common among Africans, Asians (Indians), and South Americans. Studies have shown that lighter-skinned African Americans have significantly less manifestation of the condition than darker-skinned African Americans
• Also, in over 50% of the cases, it is associated with a positive family history, potentially indicating a familial inheritance pattern

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Dermatosis Papulosa Nigra? (Etiology)

The exact cause of formation of Dermatosis Papulosa Nigra (DPN) is presently unknown.

• The condition may be inherited, since reportedly 1 in 2 cases are observed in families (positive family history identified). An autosomal dominant mode of inheritance has been proposed in such cases
• Some scientific researchers believe that it occurs due to certain developmental defects in the hair follicle; specifically, mutations involving the FGFR3 gene have been identified in DPN
• Some researchers also believe that DPN is a variant of seborrheic keratosis, which is a common benign tumor derived from epithelial cells of skin
• According to some reports, sun exposure (ultraviolet rays) may play a role in the formation of this skin condition

Dermatosis Papulosa Nigra is a non-contagious condition that cannot spread from one individual to another. This means that one cannot get it through direct contact or from being in close proximity to an individual with DPN.

What are the Signs and Symptoms of Dermatosis Papulosa Nigra?

Dermatosis Papulosa Nigra (DPN) presents multiple asymptomatic skin papules on the face. Generally, these skin lesions do not ulcerate, bleed, itch, or scale. The features of DPN skin tumors may include:

• Presence of numerous randomly placed dark brown-to-black papules on skin giving the appearance of skin spots/moles
  • A papule is an area of abnormal skin tissue that is less than 1 centimeter
  • Usually a papule has distinct borders, and it can appear in a variety of shapes
• They are mostly well-demarcated and firm to touch; some lesions are similar looking to skin tags
• Dermatosis Papulosa Nigra lesions usually range between 1 to 5 mm in size
• The skin spots usually begin appearing during adolescence; they increase in size and numbers as one age, although this can vary from one individual to another
• Most commonly, the skin lesions are noted on the face, head, and neck region. On the face, the lesions may be present on the cheeks, eyelids, and forehead
• Some can occur on the chest and upper back region too
• In some individuals, the lesions may be itchy and irritating

It is observed that the severity of the condition is higher in dark-skinned individuals than light-skinned individuals.

How is Dermatosis Papulosa Nigra Diagnosed?

A diagnosis of Dermatosis Papulosa Nigra may involve the following:

• A complete physical examination and thorough medical history (including assessment of family history of DPN, if any)
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin/tissue biopsy: A skin/tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• A differential diagnosis of other skin conditions, such as the following, is usually undertaken to rule them out. These include:
  • Adenoma sebaceum
  • Common mole
  • Seborrheic keratosis
  • Trichoepithelioma
  • Filiform (threadlike) warts

Note:

• In many, the healthcare provider can diagnose the skin condition through a comprehensive physical examination
• In a majority of cases, a tissue biopsy is not needed to arrive at a diagnosis of Dermatosis Papulosa Nigra. However, occasionally, the skin lesions may be biopsied to confirm a diagnosis of DPN
• The tissue biopsy, when examined under the microscope by a pathologist, may display features of seborrheic keratosis (another benign skin condition)
• The eruption of skin lesions on the body should not be confused for Leser-Trélat sign, which is the sudden appearance of multiple seborrheic keratosis lesions (rarely) due to an underlying malignancy

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Dermatosis Papulosa Nigra?

In many individuals, Dermatosis Papulosa Nigra does not cause any significant complications. Also, generally, ulceration, bleeding, or infections are not known to arise from these skin papules.

• Some individuals may face emotional distress (mild to severe) regarding their cosmetic appearance, especially when facial lesions are observed
• In some cases, the skin lesions may darken with time causing a greater emotional stress
• Treatment complications:
  • A treatment of DPN may result in scar (keloid scar) formation in the region, which may cause additional cosmetic issues
  • The treatment may also result in hyperpigmentation or hypopigmentation of the skin (post-operatively)

How is Dermatosis Papulosa Nigra Treated?

Usually, no treatment is necessary for Dermatosis Papulosa Nigra (DPN), unless it presents significant cosmetic issues. When required, the healthcare provider may recommend the following measures to remove the papules:

• Curettage
• Snip surgery: A fine scissors is used to snip off the DPN lesion at the base
• Freezing with liquid nitrogen or cryotherapy: This is rarely done because of the risk of altering, usually decreasing, the pigment at the area of cold treatments
• Electrodessication of the lesion
• Laser destruction

It is important to note that a treatment to remove the DPN skin lesions may result in scarring of the affected/treated region. The tendency to form scars (keloid scars) varies from one individual to another. Thus, a few lesions from areas that are not cosmetically sensitive (such as the upper back or chest region) should be removed as a trial procedure. This trial removal will help a healthcare provider in determining the scar formation tendency in the individual.

How can Dermatosis Papulosa Nigra be Prevented?

Currently, there are no known methods to prevent Dermatosis Papulosa Nigra occurrence.

What is the Prognosis of Dermatosis Papulosa Nigra? (Outcomes/Resolutions)

The prognosis for Dermatosis Papulosa Nigra is generally excellent, since it is a benign skin condition. However, the prognosis may also be stated to depend on the following factors:

• Severity of the condition causing emotional distress from cosmetic concerns
• Response to treatment: Individuals in whom scar formation tendency is not observed often show a better response to therapy than individuals with a tendency for scarring

Dermatosis Papulosa Nigra is not associated with any underlying systemic diseases or disorders. Nevertheless, it must be noted that a spontaneous regression of the papules is not observed.

Additional and Relevant Useful Information for Dermatosis Papulosa Nigra:

• The earliest description of Dermatosis Papulosa Nigra (DPN) nearly dates back 100 years and is attributed to an Italian pathologist called Aldo Castellani
• There is no evidence to prove that oily foods and chocolate-based products have an influence on the development of this condition
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition

The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse