How to Treat Dermatosis Papulosa Nigra (and What Not to Try)

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Those little dark bumps scattered across so many brown cheekbones have a name, and it isn't "moles." If you're wondering how to treat dermatosis papulosa nigra (DPN), the honest answer is that you don't have to treat it at all, and if you want the spots gone, a dermatologist removes them in the office. What you should not do is attack them at home with nail scissors, a skin tag band or a "mole removal pen" you found online. On brown and Black skin, a bad removal can leave a mark that's far more noticeable than the bump ever was.

I'm a licensed esthetician, and removing DPN is outside my lane: snipping or burning a growth off someone's face is a medical procedure (I explain where that line falls in my post on what estheticians and dermatologists each handle). What I can do is help you figure out what you're probably looking at and who to call.

What is dermatosis papulosa nigra?

Dermatosis papulosa nigra is a harmless skin condition that causes small brown to black bumps, usually 1 to 5 mm across, on the cheeks, temples, forehead and neck. It's most common in people with darker skin, tends to run in families and typically starts after puberty, with more spots showing up as you get older.

DPN is usually medically described as smooth and firm bumps, and notes they can also appear on the upper back and chest. They don't crust or open into sores. Under a microscope, DPN looks like a heavily pigmented version of a seborrheic keratosis, the common "stuck-on" growth that shows up on lots of people in middle age, which is why dermatologists consider it a variant of that condition.

A few numbers, so you know you're far from alone:

• 10% to 30% of Black people have DPN, according to a 2013 review in American Family Physician. DermNet puts the upper figure at 35% of Black Americans.
• It runs in families. In a 2020 survey of 50 African American adults with DPN, published in the Journal of Clinical and Aesthetic Dermatology, 84% had a parent, sibling or child with it too.
• Women get it more often. A review in Federal Practitioner reports that Black women are diagnosed about twice as often as Black men.

It isn't limited to Black skin. The AFP review lists Asian, Hispanic and white patients as well, and DermNet mentions people of Asian and Polynesian descent. If you have melanin-rich skin and a parent with these spots, the odds are decent you'll see a few.

How is DPN different from moles, skin tags, warts or acne?

DPN spots are tiny, dark, dome-shaped or slightly stalked bumps that cluster on the upper cheeks and temples and don't hurt. Moles are usually fewer and bigger, skin tags hang from a thin stalk in folds like the neck and armpits, warts are rough and spread, and acne comes and goes.

The confusion is understandable, and the AFP authors point out that most patients with DPN call their spots moles. Here's how I'd sort them by eye, with the big caveat that only a dermatologist can confirm what a spot is:

That last row matters. If you've been treating "acne" on your cheekbones for years and the bumps never budge, no amount of benzoyl peroxide or chemical peels is going to dissolve them. DPN isn't a clogged pore.

How do dermatologists treat dermatosis papulosa nigra?

Dermatologists remove DPN in the office, usually with light electrodesiccation (a fine electric needle, sometimes called hyfrecation after the device), tiny scissor snips, gentle curettage (scraping) or a laser. They keep the treatment superficial, because on darker skin every one of these can leave light or dark marks.

The main options:

• Electrodesiccation. This is a workhorse method. A small current dries out each bump, which then crusts and falls off.
• Snip excision. Raised or slightly stalked spots can be clipped off at skin level with fine surgical scissors. It's quick and doesn't burn the surrounding skin.
• Curettage. The bump is gently scraped away.
• Lasers. KTP, pulsed dye and Nd:YAG lasers have all been reported to work.

Why freezing is a risky choice on brown skin

Cryotherapy, the liquid nitrogen spray used on warts and regular seborrheic keratoses, is a common pick on lighter skin. On deeper skin it can kill melanocytes, the cells that make pigment, and leave pale white spots that stand out against brown skin and may not recover. If someone offers to freeze your DPN, ask why they chose that method and what they'd do about a light spot afterwards.

The real risks, even with a good dermatologist

Hyperpigmentation, hypopigmentation, scarring and keloids are always possible results of removing DPN. Keloid-prone readers should mention that history before anything touches their face. My hyperpigmentation handbook covers how to fade those marks without irritating the skin further.

Does insurance cover DPN removal?

Usually not. Because DPN is benign and doesn't cause symptoms for most people, removal is treated as elective and cosmetic, so plan to pay out of pocket. Ask the office for a price per session or per number of spots before you book anything.

Why is DIY dermatosis papulosa nigra removal a bad idea?

Cutting, banding, freezing or burning DPN at home risks infection, scarring and dark or light marks that last far longer than the bumps would have. It can also hide a spot that genuinely needed a doctor. The American Academy of Dermatology tells people not to remove seborrheic keratoses themselves.

The internet is full of shortcuts, and each fails in its own way:

• Scissors, razors and nail clippers. No sterile field, no control of depth, and a real chance of a scar on your cheekbone.
• Skin tag removal bands. They're designed to choke the blood supply to a tag on a stalk. Most DPN spots are too small and flat for that, so the band just irritates the skin around them.
• Drugstore wart freezers. You get all the pigment-loss risk of cryotherapy with none of the training.
• Acids, apple cider vinegar and "remover" creams. Leaving a strong acid on a spot burns the skin around it, and on brown skin, burned skin turns into a dark mark.
• "Plasma" or "mole removal" pens. These are burning devices sold to people with no training in how deep to go.

DIY removal tools belong on my list of skin care scams to avoid.

How to prevent dermatosis papulosa nigra: can you?

No, there's no proven way to prevent dermatosis papulosa nigra. It's strongly linked to genetics, and none of the sources I checked show that sunscreen, diet or any skin care product stops new spots from forming. Anyone selling a "DPN prevention" serum is guessing at best.

DPN does show up on sun-exposed areas like the cheeks and temples but it isn't exactly caused by the sun. Of course, if you go the removal route, you want to protect your complexion with appropriate SPF. So keep wearing sunscreen every day for all the usual reasons, and especially in the weeks after treatment, but don't expect it to stop the spots your family history is handing you.

When should a spot be checked by a dermatologist?

See a dermatologist about any dark spot that's growing fast, bleeding, itching, changing color or looking different from the rest of your spots. DPN itself is harmless, but a dermatologist is the one who can confirm a spot is DPN and not something that needs a biopsy.

The AAD's warning signs for seborrheic keratoses apply here too. Get a spot looked at if it:

• Grows quickly, turns black, itches or bleeds
• Shows up suddenly along with a crop of other new growths
• Looks different from its neighbors
• Is dry, flat, rough or scaly
• Keeps getting irritated by your collar, necklace or razor

And go if your spots simply bother you. That's a legitimate reason to book a consultation, and it's how you get a proper diagnosis before anyone removes anything.

FAQ

Can an esthetician remove dermatosis papulosa nigra?

Not in California. Removing DPN involves cutting, scraping, burning or lasering the skin, which is a medical procedure. An esthetician can help you care for your skin before and after, but the removal belongs with a dermatologist.

Does dermatosis papulosa nigra turn into cancer?

DPN itself is benign, and the AFP review describes no malignant potential. The real risk is mistaking a different, concerning spot for DPN, which is why a new or changing spot should be checked.

Do DPN spots come back after removal?

The spots that are removed usually stay gone, but because DPN tends to increase with age, new ones often appear over time. Many people plan on occasional touch-up sessions.

Will removal leave dark marks?

It can. Dark or light marks are the most common side effects on deeper skin, which is why the method and the person doing it matter so much. Ask how many patients with your skin tone they treat for DPN.

Spots, bumps and what's worth treating are topics I go deep on in my book, Under Your Skin.

Sources

• Dermatosis papulosa nigra, DermNet
• Dermatologic Conditions in Skin of Color: Part II. Disorders Occurring Predominantly in Skin of Color, Kundu RV, Patterson S, American Family Physician, 2013
• Management of dermatosis papulosa nigra: a systematic review, Jain S, Caire H, Haas CJ, International Journal of Dermatology, 2024
• Dermatosis Papulosa Nigra: A Quality of Life Survey Study, Uwakwe LN, De Souza B, Subash J, McMichael AJ, Journal of Clinical and Aesthetic Dermatology, 2020
• Key Features of Dermatosis Papulosa Nigra vs Seborrheic Keratosis, Duncan N, Usatine RP, Heath CR, Federal Practitioner
• Seborrheic keratoses: Tips for managing, American Academy of Dermatology