Case of the Month with Crutchfield Dermatology

Wednesday, December 5, 2018

What happened to this 50-year-old woman’s face?

She was afraid that it would look odd, so she opted to have half of her face treated so she could compare halves to see if the treated half looked better. She called two weeks after the initial treatment to schedule treatment for the other half. At our clinic, I treat these unsightly lesions for patients on a weekly basis.

Diagnosis: Dermatosis Papulosa Nigra

Dermatosis papulosa nigra (DPN) is a genetic condition seen in many people, especially 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.


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 hyfrecation to all the papules until they turn a light gray 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 percent of the treated lesions require no additional treatment. About 30 percent will develop a mild to moderate postinflammatory hyperpigmentation that can be treated with a topical preparation containing a combination of hydroquinone, retinol, hydrocortisone and kojic acid.

For more information, contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology or visit