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INTRODUCTION

KEY POINTS

  • Dermatosis papulosa nigra (DPN) is a common skin disorder in many patients with skin of color.

  • DPN are benign pigmented papules that appear on the face, neck, and trunk.

  • There is a genetic predilection, with a family history of DPN reported by at least 50% of affected individuals.

  • DPN is rare in childhood and the number and size of lesions increase with age.

  • The pathology of DPN is similar to that of seborrheic keratosis.

  • DPN has a chronic progressive course.

  • DPN can be treated electively by simple excision electrodesiccation or laser.

Dermatosis papulosa nigra (DPN) is a condition where benign, darkly pigmented papules appear primarily on the face, neck, and trunk of women and men with skin of color worldwide.1 DPN is often called pigmented papules, skin tags, or flesh moles. The incidence of DPN is reported to be as high as 70% in the African American population and up to 50% among family members of affected patients [Figure 22-1].2,3

FIGURE 22-1.

A man with skin type VI with periocular and temple pigmented papules.

A retrospective study of 1000 Afro-Caribbean subjects ranked DPN as a common finding.4 In Africa, 40% of the population over the age of 30 has DPN.1,5 Similar lesions have been described in Asians, Hispanic, and Latin Americans [Figure 22-2], although the exact incidence is unknown.2,6,7

FIGURE 22-2.

Dermatosis papulosa nigra on a Hispanic woman.

The development of DPN in children, although rare, has been reported.8 It is chronic and progressive in adults. Although DPN is generally asymptomatic, the papules can become pruritic and burning.9 Treatment is often pursued to enhance cosmetic appearance.

ETIOLOGY AND PATHOGENESIS

Castellani2 reported the first case of DPN in 1925, but the exact etiology remains uncertain. It is speculated that DPN is derived from an epidermal nevus or a hamartoma with follicular origin or from a nevoid developmental defect of the pilosebaceous follicles.10,11,12 The preponderance of DPN within certain families suggests a strong genetic predilection.11 Niang et al13 suggest that the sun may be an etiopathogenic factor in the increase in lesions in the African population.

CLINICAL FINDINGS

DPN may begin as early as the first decade of life.8 However, these small, darkly pigmented papules usually begin in adolescence and progress slowly over the years, peaking in number in the sixth decade.11 The average age of onset is 22 years.12 DPN has been reported to have between a 1:1 and 2:1 female-to-male ratio of incidence.1 Family history of ...

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