Dermatosis Papulosa Nigra

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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. See the image below.



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Dermatosis papulosa nigra. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/lesions/dpn2.jpg).

Pathophysiology

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

Epidemiology

Frequency

Whereas earlier US studies revealed a 10% frequency in adult blacks, more recent data suggest a frequency of approximately 35% in this population. Data pertaining to the international frequency of dermatosis papulosa nigra are insufficient.

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.

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.

History

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

Physical Examination

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]

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.

Approach Considerations

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, 7, 8] Both EMLA (topical lidocaine/prilocaine cream) and LMX (topical lidocaine cream) creams are effective for providing topical anesthesia.[9] Use caution with all therapies to minimize the depth of treatment.

Author

Mehran Nowfar-Rad, MD, Facey Medical Group

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

Disclosure: Nothing to disclose.

Specialty Editors

Michael J Wells, MD, FAAD, Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Disclosure: Nothing to disclose.

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

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

Disclosure: Nothing to disclose.

References

  1. Dunwell P, Rose A. Study of the skin disease spectrum occurring in an Afro-Caribbean population. Int J Dermatol. 2003 Apr. 42(4):287-9. [View Abstract]
  2. Grimes PE, Arora S, Minus HR, Kenney JA Jr. Dermatosis papulosa nigra. Cutis. 1983 Oct. 32(4):385-6, 392. [View Abstract]
  3. Babapour R, Leach J, Levy H. Dermatosis papulosa nigra in a young child. Pediatr Dermatol. 1993 Dec. 10(4):356-8. [View Abstract]
  4. Hairston MA Jr, Reed RJ, Derbes VJ. Dermatosis papulosa nigra. Arch Dermatol. 1964 May. 89:655-8. [View Abstract]
  5. Kauh YC, McDonald JW, Rapaport JA, Ruschak PJ, Luscombe HA. A surgical approach for dermatosis papulosa nigra. Int J Dermatol. 1983 Dec. 22(10):590-2. [View Abstract]
  6. 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. 2008 Jun. 10(2):120-2. [View Abstract]
  7. Ali FR, Bakkour W, Ferguson JE, Madan V. Carbon dioxide laser ablation of dermatosis papulosa nigra: high satisfaction and few complications in patients with pigmented skin. Lasers Med Sci. 2016 Apr. 31 (3):593-5. [View Abstract]
  8. Karadag AS, Ozkanli ┼×, Mansuroglu C, Ozlu E, Zemheri E. Effectiveness of the Pulse Dye Laser Treatment in a Caucasian Women With Dermatosis Papulosa Nigra. Indian J Dermatol. 2015 May-Jun. 60 (3):321. [View Abstract]
  9. 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. 2006 Jan. 32(1):1-6. [View Abstract]
  10. Andrews GC, et al. Andrews' Diseases of the Skin. 8th ed. Philadelphia, Pa: WB Saunders; 1990. 752.
  11. Elder D, et al. Lever's Histopathology of the Skin. 8th ed. Philadelphia, Pa: Lippincott-Raven; 1997. 693.
  12. Moschella SL, Hurley HJ. Dermatology. Philadelphia, Pa: WB Saunders; 1992. 2162-3.
  13. Rook A, Wilkinson DS, Ebling FJG. Textbook of Dermatology. Oxford, England: Blackwell Scientific; 1998. Vol 2: 1660-1.

Dermatosis papulosa nigra. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/lesions/dpn2.jpg).

Dermatosis papulosa nigra. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/lesions/dpn2.jpg).