Dermatosis Papulosa Nigra Removal

Dermatosis Papulosa Nigra (DPN) are common in people with dark skin, especially in African Americans. Perhaps the most famous person with these mole like protuberances on his face is actor Morgan Freeman. DPNs tend to appear on the face, neck and upper torso regions most frequently.

DPN Overview

DPN lesions generally emerge during puberty and usually have a genetic hereditary propensity (similar to seborrheic keratoses). They typically occurs in individuals with Fitzpatrick skin types III to VI. Therefore, people of South Asian and African heritage tend to have higher occurrence rates of Dermatosis Papulosa Nigra. Women are also more likely to have Dermatosis Papulosa Nigra.

DPN is considered to be a common variant of seborrheic keratoses (SKs). It was first described in 1925 by Dr. Aldo Castellani, based on his observations while visiting Jamaica and Central America. DPN papules (bumps) appear as 1 to 4 mm brown or black dots that resemble moles. They tend to increasing steadily in number and size as a person ages, with spontaneous regression highly unlikely. The DPN marks are almost always benign and noncancerous, with no treatment required. However, people may wish to remove them if they find them to be cosmetically undesirable.

One study found that people with darker skin who used skin lightening creams tended to have a larger number of DPN bumps. This could be due to reduced UV ray protection from the loss of protective skin pigment melanocytes.

Dermatosis Papulosa Nigra Removal

Dermatosis Papulosa Nigra Removal
Dermatosis Papulosa Nigra (DPN) removal from face using a pulsed dye laser. Source: Indian Journal of Dermatology.

DPN removal options include the following surgical and non-surgical methods:

  • Scissor excision via snipping.
  • Cryotherapy. Liquid nitrogen is generally used to freeze off the bumps. However, in people with darker skin, cryotherapy can cause hypopigmenation or hyperpigmentation due to potential damage of melanocyte cells.
  • Curettage. A dermatologist will scrape off the bumps with a small surgical instrument.
  • Electrocautery. An electric current runs through a small probe with a fine needle electrode tip. This current burns (cauterizes) the DPN skin tissue, but does not pass through the patient’s body.
  • Electrodesiccation. A professional will zap the bumps with a low electric current using a probe. Topical anesthesia is usually applied before this treatment. This procedure (also called fulguration) uses heat from the electric current to pass through and destroy the abnormal DPN tissue.
  • Laser Therapy. Among lasers that have been used to successfully remove Dermatosis Papulosa Nigra in patients include: potassium titanyl phosphate (KTP) lasers; pulsed dye lasers (PDL); Nd:YAG lasers; Q-switched and picosecond lasers; and CO2 lasers. In general, the Nd:YAG 1064 nm wavelength lasers are the most suitable for people with dark skin. However, talk to your dermatologist to see which is best for your type of skin.

Scarring, dyspigmentation, skin discoloration, greying, crusting, and keloid formation are potential complications that can arise after Dermatosis Papulosa Nigra removal. Note that DPN lesions can always recur after treatment with any of the above modalities.


DPN versus Seborrheic Keratoses

Dermatosis Papulosa Nigra (DPN) is considered to be a common variant of seborrheic keratoses (SKs). However, a recent report denoted some major differences between the two.

  • While DPN affects darker skin types, SKs are far more common in lighter-pigmented individuals with Fitzpatrick skin type I to II.
  • DPN lesions are largely limited to sun-exposed areas of the body (face and neck). In contrast, SKs have a more widespread distribution.
  • Morphologically, DPN lesions are relatively small and uniform. SKs on the other hand vary widely in size and shape. Some seborrheic keratosis diameters can reach several centimeters in size.
  • While DPN and SKs genetically share a common somatic activating mutation (FGFR3), DPN lacks the mutation in PIK3CA that is found in SKs.

Post Treatment Care

After treatment, one must take a number of precautions. Sun exposure should be kept at a minimum, and always after application of sunscreen. Do not pick at your lesions and treated areas, even if their is significant itching. Try not to use any kinds of creams, makeup, acid containing products or other potentially harmful lotions with chemical ingredients.

Tranexamic Acid for Skin Lightening and Melasma

Tranexamic Acid Face Serum Minimalist.
Minimalist 3% tranexamic acid face serum for pigmentation and acne scars.

In recent years, Tranexamic Acid (TXA) has become increasingly popular for skin lightening and treating conditions such as melasma and dark spots. Tranexamic acid is a tyrosinase inhibitor and has anti-inflammatory properties that can even out skin tone. Note that TXA has not been officially licensed for use in dermatological conditions, so it is used off-label for skin applications.

Historically, tranexamic acid has been used to treat excessive blood loss (from surgery, postpartum bleeding, heavy menstruation and more) due to its blood clotting properties.

How does Tranexamic Acid Work?

According to DermNet NZ, the mechanism of action of tranexamic acid involves the shrinkage of dermal vasculature and reduced melanin synthesis. The latter is achieved via altering the interaction of keratinocytes and melanocytes, and via reduced tyrosinase activity. There are a number other products that reduce hyperpigmentation via tyrosinase inhibition.

Most topical products that contain tranexamic acid use 2% to 5% formulations. The oral dose used to treat melasma is 250 mg twice per day. A 2021 study found that a new topical tranexamic acid derivative improved overall facial skin tone and reduced the appearance of dark spots and redness.

Topical Skin Serums and Lotions

Tranexamic Acid Serum
Tranexamic acid 5% serum from Dearskin.

There a number of popular commercial lotions and serums that contain tranexamic acid. Among the most popular ones on Amazon is a 5% Tranex serum from Dearskin. It has an average rating of 4.3 out of 5 stars based on almost 1,000 reviews as of today. It is currently on sale for just $15 after a coupon discount.

Besides containing TXA, this product also includes other proven skin lightening and brightening ingredients such as kojic acid, niacinamide, vitamin C, hyaluronic acid and glycolic acid. Tranex has been tested by dermatologists and is cruelty free and vegan (not tested on animals). It is also formaldehyde- and paraben-free, and is made in the USA.

Another recommended product is The INKEY List’s tranexamic acid 2% hyperpigmentation treatment gel. The low concentration makes this a good option to start experimenting with TXA. It also contains acai berry extract and Vitamin C.

Using Tranexamic Acid in Skin of Color

Dr. Rattan has a great video titled: “Is Tranexamic Acid Suitable For Skin Of Color”. She is a fan of this ingredient since it is skin neutral. It works best on pH 5-7, which is approximately the same pH level as our skin. Dr. Rattan prefer to use tranexamic acid in combination cocktail products rather than via monotherapy, especially for stubborn melasma conditions.

Potential Side Effects

In general, Tranexamic acid is safe and well-tolerated by all skin types (assuming you use a reputable product and low dosage). Mild side effects include skin irritation, scaling or flaking, dryness and erythema. Most of these can be reduced with the use of moisturizer creams. Moreover, note that TXA can also reduce post-inflammatory erythema (PIE) and post-inflammatory hyperpigmentation (PIH) due to its anti-inflammatory effect.

Laser Hair Removal Burns on Dark Skin

As a dark skinned person, if you do not use an ideal laser type (usually Nd:YAG) for your hair removal, burn injuries and permanent skin damage are serious possibilities. This week, a number of dermatologists have discussed the sad and shocking burn scars on a brown skinned girl who had laser hair removal on her arms using an incorrect wavelength device.

Among doctors who specialize in ethnic skin treatments that mentioned this case on Instagram include:

1) Dr. Corey Hartman

Laser Hair Removal Burn Injury
A darker skinned patient suffered terrible burns on her arm after laser hair removal with an incorrect laser.

2) Dr. Alexis Stephens

3) Dr. Adeline Kikam

Laser Burn Injuries in Dark Skin

In all the above linked posts, there are hundreds of comments from readers. Some experienced similar burn injuries to this girl after getting laser treatments at inexperienced run-of-the-mill clinics. While most lasers will not cause dark permanent burn marks on people with lighter skin tones, the same is not true when treating darker skin tones.

Also adding to the confusion, if you are on the lighter end of brown skin complexion, you can be treated with other lasers (e.g., the Diode) besides the Nd:YAG. It is imperative to do thorough research on whichever laser your clinic will use for your hair removal. Also ask to see their before and after patient photos of customers with a similar skin type as yourself.

Laser light energy based treatments are not to be taken lightly. Skin damage is often permanent. Moreover, hyperpigmentation and burn mark side effects after incorrect treatment in people of color tend to be far more evident and longer-lasting.