Understanding DPN: Navigating Dermatosis Papulosa Nigra on Black Skin

It’s likely you’ve seen them but don’t know what they are, or you may have been calling them skin tags or moles or even blackheads, but those small browny/black lumps and raised patches, sometimes of different sizes that you can find on face, neck and chest are called Dermatotis Papulosa Nigra, aka DPN.

They are a common skin concern for those with darker skin tones, with around one-third of Black people being affected. They aren’t harmful and don’t indicate any other health issues, but they can be aesthetically unappealing or annoying if constantly being caught in clothes or jewellery, so very understandable why DPN removal is often a question that comes up.

What Is DPN?

Dermatosis Papulosa Nigra is a benign skin condition characterised by small, dark, raised bumps. They can be round, oval, long, short, flat or protrude from the skin.

Singing sensation, Beyoncé with a fine smattering of DPN

Typically, they begin to develop during adolescence or early twenties, but they can occur at any age during adulthood, and they usually become more numerous over time. Some people may only be affected by a small number, while others may have a more dense appearance (consider Morgan Freeman).

Consultant Dermatologist Dr Mary Sommerlad tells us that DPN can ‘range from being less than 1mm to several millimetres wide.’ They can also have a smooth or slightly rough texture. Both men and women can develop DPN, although women are somewhat more likely to be affected. Dr Sommerlad adds, ‘DPN can appear anywhere on the body but are particularly noticeable on the cheeks, neck and between and under the breasts’. It is most common for DPN to occur on the face, but about one in four people with DPN will also have them on their body.

The Causes

The exact causes of DPN are unknown. There are are number of contributory factors:

  • Genetics – Dermatosis Papulosa Nigra are more likely to occur in people who have family members with the condition.

  • Melanin production – DPN is more common in people with deeper skin pigmentation (Fitzpatrick classifications 4-6), although the exact reason for this is not understood.

  • UV Exposure – DPN lesions often appear in people who have a history of sun exposure, however the connection isn’t completely clear and is debated.

  • Skin Lightening Creams – It has been noted that people who have used skin-lightening creams are more likely to develop DPN. This may be due to the skin being more sensitive to UV light.

  • Hormonal fluctuations – In some instances, DPN can become darker, increase or more noticeable during pregnancy and menopause.

It is important to acknowledge that because we don’t fully understand why DPN develops, it can occur without any of these factors applying. For example, DPN can develop on fairer melanated skin or for someone with no family history of the condition.

Should I Be Worried About Having DPN?

Dermatosis Papulosa Nigra are harmless and aren’t linked to other skin health concerns. Dr Sommerlad says that DPN do not need to be removed from a medical perspective. However, they can cause skin irritation if they are rubbing on glasses or a bra strap, which makes them bothersome.

Some people may also dislike the appearance of DPN, or find that the texture affects makeup application, leading to considering removal. Unfortunately, as they are primarily genetic, it’s impossible to prevent them from occuring. Considering that UV exposure may be connected to DPN development, using a daily sunscreen and avoiding direct sun exposure for long periods is recommended.

Golden Globe winning actor Morgan Freeman with DPN

Dermatosis Papulosa Nigra don’t cause any breakages on the skin, scaling or crusting. If you’ve developed any dark bumps on the skin, which are bleeding, releasing fluid, or have an unusual texture, it is essential to speak with a medical professional to investigate further.

But… you still want to remove DPN

There are several options for removing DPN lesions, depending on your personal concerns and the extent of the condition.

  • Electrolysis

Electrolysis involves inserting a fine needle into the DPN lesions and applying an electric current, which causes a heating effect. This causes the bump to break down and dry up. Following Electrolysis, DPN lesions will scab over and drop off within 10-14 days.

When performed by an experienced professional, Electrolysis is highly effective and precise, meaning the surrounding skin should not be affected.

  • Cryotherapy

Cryotherapy uses liquid nitrogen to freeze the DPN lesions off the skin. It is often the most affordable option and can also effectively remove more dense areas of lesions.

Although highly effective, Dr Sommerlad emphasises the importance of finding an experienced practitioner when considering Cryotherapy, as there is a risk of pigment loss (hypopigmentation).

  • Curettage

Curettage involves the surgical removal of DPN lesions by scraping them off the skin using a small blade. This typically involves a local anaesthetic to numb the area and reduce discomfort. This method may be less suitable for areas affected by many bumps, as it may be painful. There is also a risk of hyperpigmentation or hypertrophic scarring, so again, as we always say, it’s important to see an experienced skin or medical professional.

  • Laser

Laser treatment is a highly effective option for treating DPN. Unlike other treatment options, Laser may not completely remove the lesions but can reduce their appearance. Dr Sommerlad recommends the use of an ND:Yag laser for this as it is more suited to treating darker skin tones without side effects such as hyperpigmentation or hypopigmentation.

You may require several sessions of laser treatment to effectively reduce the appearance of DPN, and it is crucial to find a practitioner who is experienced in treating specifically DPN as well as using laser on darker skin tones for the best results.

It’s worth bearing in mind that even with removal, DPN can come back to the same or to other areas over time.

DPN Treatment Considerations

Although DPN removal is popular for cosmetic reasons, it is important to keep the following factors in mind:

  • Find the Right Practitioner

DPN treatment typically requires inflicting some level of controlled trauma to the skin, because Black skin is at more risk of discolouration it’s imperative to find a qualified practitioner who is experienced specifically in DPN removal to avoid unwanted outcomes.

  • Take your time and ask questions

It’s unlikely you know what will be the best removal option for you, so speak to a number of practitioners who can discuss the available options which may address your concerns best. This may depend on the number of lesions you wish to be removed and how many treatment sessions you are prepared to undertake.

  • Scarring

If you are prone to hypertrophic (raised) or keloid scarring, tell your practitioner as they have to consider it alongside any treatment option. This will help them devise a safe treatment plan for you. In some instances though they may also advise against treatment unless the lesions are causing skin irritation.

Next steps

Remember that there is no safe at-home treatment to remove DPN, so if you are considering DPN removal or treatment, check out our Clinic Search Directory for experienced and qualified DPN and Black skin practitioners.

Once DPN has been removed successfully, stay on top of your skincare - keeping skin clean and moisturised to encourage healing and be vigilant with your sunscreen of at least SPF30.

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