A Systematic Review on the Treatment of Dermatosis Papulosa Nigra

April 2021 | Volume 20 | Issue 4 | Original Article | 467 | Copyright © April 2021


Published online March 19, 2021

Jalal Maghfour MDa, Temitayo Ogunleye MDb

aDepartment of Medicine, Tulane University School of Medicine, New Orleans, LA
bDepartment of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA

Abstract
Dermatosis papulosa nigra (DPN) is a benign skin condition that is primarily reported in skin of color patients. While prevalent, treatment options are limited and the benign course of DPNs may cause them to be overlooked by clinicians. However, large and multiple lesions in cosmetically sensitive areas may be emotionally and socially distressful to patients. There are few literature reviews examining treatment options for this condition. A literature search was performed using PubMed, Medline, Embase, and Web of Science databases. 67 articles were identified and 15 studies met the inclusion criteria. Our findings demonstrate that laser therapy is becoming increasingly utilized as a safe and efficacious treatment for DPNs in skin of color patients.

J Drugs Dermatol. 20(4):467-472. doi:10.36849/JDD.2021.5555

INTRODUCTION

Dermatosis papulosa nigra (DPNs) are benign epidermal growths and are considered a variant of seborrheic keratoses.1 DPNs primarily affect darker skinned individuals with Fitzpatrick skin types III–VI, and have a predilection for women of African and Asian descent.1 While the exact prevalence remains unknown, up to one third of African Americans have been diagnosed with DPNs.1 DPNs are classically described as asymptomatic brown to dark brown papules found on the cheeks and periocularly, but may occur on other parts of the face, neck, chest, and back. Lesions may be filliform or sessile, and are typically 2–10 mm in size.2 Despite the benign nature of this condition, the number and size of DPNs may increase with age. Because of its predilection for the face, head and neck, DPNs can be cosmetically displeasing and it has been reported that DPNs may negatively impact patients’ quality of life.3

Typical treatment recommendations include light electrodesiccation with/without curettage, cryotherapy, and snip excision with scissors with various levels of efficacy.4 Treatment is usually pursued cautiously to avoid post-inflammatory hyperpigmentation (PIH) and scarring in darker skinned individuals. New emerging therapies such as laser treatments are being increasingly utilized as an alternative therapy. To the best of our knowledge, there is little to no summative data on DPN treatments. The aim of this review is to summarize the evidence in the literature examining various treatments for DPN.

MATERIALS AND METHODS

A comprehensive systematic review was performed using Pubmed, Medline and Embase databases in June 2020. The search included the following terms: (“dermatosis papulosa nigra” OR “DPN”) AND (“treatments” OR “therapies”). Studies were searched from 1960 to June 2020. Full-text articles reporting treatment types and outcomes were included. Studies were excluded for the following reasons: 1) no specific descriptions of treatment types 2) no treatment outcome measured 3) non-English articles.

RESULTS

67 non-duplicated articles were identified, and 35 articles were screened for full-text eligibility; 15 met the inclusion criteria and were included in the systematic review. This included six cohort studies, one "randomized clinial trial (RCT), five case reports/case series and three pilot studies.

Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)5 guidelines (Figure 1).

Treatments
Curettage and Electrodesiccation
Electrodesiccation is a subtype of electrosurgery that causes tissue destruction via heat production. It is anecdotally considered the standard therapy among many dermatologists (with or without curettage) for the treatment of benign lesions such as DPNs. In a comparative randomized study,6 electrodesiccation yielded a higher rate of lesion resolution (92.5%) than laser (88%), but this was not statistically significant (P>0.05). However, PIH was commonly reported among patients treated with electrodesiccation.7 Pigmentary side effects were