Dermatosis Papulosa Nigra (DPN), often referred to as skin tags, is a common dermatological condition that presents as small, benign lesions on the skin. While generally harmless, these dark, raised papules can cause cosmetic concerns for many individuals, affecting their self-esteem. Understanding DPN’s symptoms, causes, diagnosis, and treatment options can empower those affected to effectively manage and address this condition, as knowledge is key to power.

What is Dermatosis Papulosa Nigra (DPN)?

Dermatosis Papulosa Nigra (DPN) is a common, benign skin condition characterized by small, dark, raised lesions on the skin. Although it primarily affects individuals with darker skin tones, it can occur in all skin types. These lesions, known as skin tags, are generally harmless but can be cosmetically concerning as more and more appear.

DPN can be easy to spot as as skin tags develop, such as on the skin of this patient – notice the raised, dark bumps present.

DPN as a Variation of Seborrheic Keratosis

Dermatosis Papulosa Nigra (DPN) is considered by some experts to be a variation of seborrheic keratosis. Histologically, DPN resembles seborrheic keratoses and shares a mutation in FGFR3 with seborrheic keratoses. However, it does not involve a mutation in PIK3CA. The condition may be cosmetically undesirable to some patients.

Symptoms of Dermatosis Papulosa Nigra (DPN)

Dermatosis Papulosa Nigra DPN presents with distinctive features that can help in its identification even from home:

Primary Symptoms

• Small, Dark Papules: These are the hallmark of DPN, appearing as dark brown or black papules ranging from 1-5 mm in diameter. They are flexible to the touch and easy to measure from side to side.
• Raised Lesions: The papules are typically raised and can have a smooth or rough surface.
• Location: Commonly found on the face, particularly around the cheeks and eyes, but can also appear on the neck, chest, and back.

Secondary Symptoms

• Cosmetic Concerns: The appearance of these lesions can be considered cosmetically unattractive.
• Itching or Irritation: In some cases, the papules may become infected or irritated if rubbed or scratched repeatedly on purpose or by mistake, such as by clothing rubbing the papules during everyday movement.

What Causes Dermatosis Papulosa Nigra (DPN)?

The exact cause remains unclear, but several factors are believed to contribute to DPN’s development:

1. Genetics:
   There is a strong genetic component to DPN, as it often runs in families. Individuals with a family history of DPN are more likely to develop the condition.
2. Age:
   DPN is commonly found in middle-aged and older adults. However, DPNs can be seen in patients of any age.
3. Skin Type:
   DPN predominantly affects individuals with darker skin tones, particularly those of African descent.
4. Nevoid Developmental Defects: Dermatosis Papulosa Nigra is can be caused by a nevoid developmental defect of the pilosebaceous follicle.

Epidemiology and Demographics

A study in the International Journal of Dermatology states that DPN tends to occur in females with Fitzpatrick skin types IV to VI. The lesions commonly develop in the head and neck. They are often associated with a family history of DPN and significant sun exposure.

Like the other patient above, notice the dark, raised spots on her skin – the telltale sign of DPN, many skin tags.

How is DPN Diagnosed?

Diagnosis of DPN is typically straightforward and involves:

1. Physical Examination:
   Dermatologists can diagnose DPN by visually examining the skin and identifying the characteristic papules to clear out other causes or skin disorders like cancers.
2. Dermatoscopy:
   In some cases, dermatoscopy may examine the lesions more closely to differentiate them from other skin conditions.
3. Biopsy:
   Rarely, a skin biopsy may be ordered to rule out other conditions.

Severity Classification

Though benign, dermatologists classify DPN lesions according to severity:

• Fewer than ten papules: Mild
• More than ten papules: Moderate
• Greater than fifty papules: Severe

DPN vs. Regular Moles

DPN is unlike regular skin moles, which are more aligned with skin follicles. Moles occur when skin cells, known as melanocytes, clump up. Melanocytes produce melanin, which colors our skin. While normally evenly distributed, they will occasionally come together. A malignant growth tends to be an asymmetrical mole. DPN lesions, where one side is a different shape from the other, are pretty standard. DPN bumps both increase in size and grow in number over time.

How Do You Treat Dermatosis Papulosa Nigra (DPN)?

Treatment of DPN is generally not medically necessary but may be sought for cosmetic reasons.

Cosmetic Treatments

• Cryotherapy: Freezing the papules with liquid nitrogen to remove them.
• Electrosurgery: Using electrical currents to remove the papules.
• Laser Therapy: Utilizing ablative laser technology to target and remove the lesions precisely.
• Excision: Surgically cutting out the papules, usually performed by a dermatologist.

Topical Treatments

• Retinoids: Topical retinoid creams can sometimes help reduce the appearance of DPN, although their effectiveness varies.

Self-Care

• Avoid Irritation: Patients are advised to avoid scratching or rubbing the lesions to prevent irritation.
• Regular Monitoring: Regular check-ups with a dermatologist to monitor the condition and manage any changes.

Frequently Asked Questions (FAQ)

• Is Dermatosis Papulosa Nigra treatable? The condition benign and doesn’t call for treatment unless it affects a person’s lifestyle; several cosmetic procedures can effectively remove the lesions or reduce their appearance.
• Is Dermatosis Papulosa Nigra hereditary? Yes, there is a significant genetic component, making it more common in individuals with a family history of DPN.
• What causes Dermatosis Papulosa Nigra? The exact cause is unknown, but genetics, age, and skin type are contributing factors. Practicing sun safety and having a skincare routine are extraordinary preventative measures.
• How can I treat Dermatosis Papulosa Nigra? Treatment options include cryotherapy, electrosurgery, laser therapy, and excision. Consult a dermatologist for the best approach. Complete a free consultation for your hair loss with board-certified dermatologist Dr. Sanusi Umar to see how the real-life Bumpinator can help you!
• Can Dermatosis Papulosa Nigra be prevented? Since the exact cause of DPN is not fully understood and it often runs in families, prevention is not clearly defined outside of making smart, generally skin-safe decisions.

References

Furukawa, Fumina et al. “Treatment of dermatosis papulosa nigra using a carbon dioxide laser.” Journal of cosmetic dermatology vol. 19,10 (2020): 2572-2575. doi:10.1111/jocd.13309

Maghfour, Jalal, and Temitayo Ogunleye. “A Systematic Review on the Treatment of Dermatosis Papulosa Nigra.” Journal of drugs in dermatology : JDD vol. 20,4 (2021): 467-472. doi:10.36849/JDD.2021.5555

Nowfar-Rad, Mehran, MD; Elston, Dirk M., MD. “Dermatosis Papulosa Nigra.” Medscape, Jun 07, 2022.

Tran, Mimi, and Vincent Richer. “Elective Treatment of Dermatosis Papulosa Nigra: A Review of Treatment Modalities.” Skin therapy letter vol. 25,4 (2020): 1-5.

Xiao, Anny, et al. “Dermatosis Papulosa Nigra.” StatPearls, StatPearls Publishing, 7 August 2023.