A 46-year-old man presented to the clinic for the evaluation and treatment of multiple dark brown papules that developed on his face over the past several years. He reports that the lesions have been increasing in both number and size over the past four to five years. The patient also reports that several senior members of his family have similar lesions.
What is your diagnosis?
Diagnosis: Dermatosis Papulosa Nigra.
Discussion: Dermatosis Papulosa Nigra (DPN) is a genetic condition seen in many people, especially in people of color. Dermatohistopathologically, the lesions are very similar if not identical to small seborrhoeic keratoses. At times, the lesions can be pruritic or irritated if they occur in an area where the patient is shaving. The majority of the lesions occur on the face and neck, but they also can occur on the chest and back. In most cases, the lesions are an aesthetic concern for patients.
Treatment: My approach to the treatment of Dermatosis Papulosa Nigra is to apply a topical anesthetic cream for 15-30 minutes followed by individual lesion injection anesthesia. I use light hyfercation to all the papules until they turn a light grey in color. After that, I use mild gauze massage/rubbing to the treated lesions. I use a topical antibiotic cream on the area twice daily for the next seven days. In my experience, remarkably, approximately 70% of the treated lesions require no additional treatment. About 30% will develop a mild to moderate post inflammatory hyperpigmentation that can be treated with a topical preparation containing a combination of hydroquinone, retinol, hydrocortisone, and kojic acid.
As you can imagine the patient presented above was extremely pleased with the results. This DPN treatment procedure is one I’ve performed on hundreds of patients over the years including the other two examples I’ve shown you below.
Figure 3 and 4 represents famous major league baseball player Tony Oliva (Mr. Oliva gave me permission to identify himself in this case of the month). In his particular case he was travelling to visit his family in Cuba and even at the age of 74 he said, “I want these treated, so my sister doesn’t tease me when I go home.”
Figure 3: Before treatment
Figure 4: After treatment
Figure 5: Before treatment
Figure 6: After treatment