Elective Treatment of Dermatosis Papulosa Nigra

A Review of Treatment Modalities

Mimi Tran, MD; Vincent Richer, MD, FRCPC, FAAD

Disclosures

Skin Therapy Letter. 2020;25(4):1-5. 

In This Article

Abstract and Introduction

Abstract

Dermatosis papulosa nigra is a benign skin lesion found most frequently on the face of patients with skin of color. Elective treatment is occasionally requested. However, in view of knowledge gaps regarding aesthetic treatments for skin of color, patients can be exposed to unnecessary risks or simply denied treatment options due to physician reservation. Cosmetic treatments should balance efficacy of lesion removal while minimizing pigmentary complications. In this review, we describe the few published treatment modalities for dermatosis papulosa nigra. Alongside established surgical techniques, laser devices including the 532-nm potassium-titanyl-phosphate laser, 532-nm diode laser, 585-nm pulsed dye laser, 1064-nm neodymium-doped yttrium aluminum garnet laser, 1550-nm erbium-doped fractionated laser and the 10,600-nm carbon dioxide laser have been successfully reported. The insight from this review can assist in increasing our understanding of safe and effective treatments for conditions that are common on skin of color.

Introduction

Dermatosis papulosa nigra (DPN) is a benign skin lesion found in patients with skin of color, particularly in individuals of African or Asian descent.[1–4] Lesions are often categorized as a variant of seborrheic keratosis and preferentially occur on the face.[4] They are associated with similar FGFR3 gene mutations as seborrheic keratosis.[4–6] However, unlike seborrheic keratosis, DPN tend to present earlier in life and are more commonly found in women.[1,5,7,8] Histopathological findings show similarities to acanthotic seborrheic keratosis.[1–3] On dermoscopy, DPN show comedo-like openings, fissures and ridges representing a cerebriform-like pattern.[1,7] Clinically, they present as brown papules that are typically asymptomatic but can have associated pruritus.[3,9] Although they are benign in nature, DPN can be cosmetically displeasing and patients occasionally seek elective removal. Physician reservations and knowledge gaps concerning aesthetic treatments for skin of color are widespread, especially when it comes to the use of energy-based devices.[10] Consequently, patients may be denied the opportunity to discuss available options or exposed to additional unnecessary risks, especially adverse pigmentary changes with inappropriate treatment selection. This knowledge gap applies to the treatment of DPN and creates an opportunity for review of published elective therapeutic procedures.

Treatment options for DPN include surgical techniques, such as cryotherapy, curettage, and electrodessication, as well as laser therapy. Many laser options for DPN have been documented, including the 532-nm potassium-titanyl-phosphate (KTP) laser, 532-nm diode laser, 585-nm pulsed dye laser (PDL), 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, 1550-nm erbium-doped fractionated laser, and the 10,600-nm carbon dioxide (CO2) laser. Adverse effects of treatment include pain, crusting, dyspigmentation, scarring, and recurrence. The ideal treatment would be effective at clearing the lesions while circumventing pigmentary complications that conventional surgical treatments can produce, especially in a disorder common on skin of color.

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