After more than a decade as a beauty editor, I’ve gotten pretty good at identifying common skin concerns. Am I a dermatologist? Absolutely not. But after years of interviewing experts and reporting on the latest treatments, I’d like to think I know more than the average person.
That’s why I was surprised when a casual conversation at dinner during the American Academy of Dermatology’s annual meeting in Denver left me stumped. While chatting with New York-based dermatologist Dr. Victoria Humphrey, I pointed out a cluster of spots on my cheekbones and asked what she thought they were. When I first noticed them a few years ago, I assumed they were acne marks, despite not remembering any major breakouts in that area. Later, I wondered if they might be sun spots from my years living in Miami. As it turns out, they were neither. Dr. Humphrey quickly identified them as dermatosis papulosa nigra (DPN), a common benign skin condition sometimes nicknamed “Black girl freckles.”
As a mixed-race woman (Japanese and Puerto Rican), the diagnosis caught me off guard. While DPN is most commonly associated with Black skin, it can also affect people of Asian, Hispanic, and other ethnicities. My spots are a lighter brown than what’s often seen on Black skin, but they fit the classic description: clustered in pattern, slightly raised, and unresponsive to every brightening serum I’d tried, including my beloved SkinCeuticals C E Ferulic.
Ahead, here’s everything I learned about DPN, from what causes it to the treatment options worth considering.
What is DPN, and how does it differ from skin tags, moles, or other hyperpigmentation?
DPN is a benign skin condition that typically begins appearing in your late 20s or early 30s as small, raised spots that cluster together. While they’re most commonly found on the cheeks, eyelids, and temples, they can also pop up on the neck, chest, shoulders, and upper back. If you’re still not sure what DPN looks like, there’s a good chance you’ve seen it before: “Morgan Freeman is probably the most recognizable celebrity with DPN, which is why people often search for the condition online as ‘Morgan Freeman moles,’” says Dr. Humphrey.
This is the point in the conversation where I was shocked at how much of this was new information — but one reason DPN often flies under the radar is because it’s easy to mistake for other common skin concerns, especially hyperpigmentation, moles, or skin tags.
Here’s how Dr. Humphrey explains the difference: “Skin tags are soft, fleshy, and usually found in folds like the neck or underarms,” she says, adding, “Warts have a rough, cauliflower-like texture and can appear anywhere on the body, from the face to the feet.” Then there’s moles: “These can be flat or raised, they grow from deeper layers of the skin and often appear singly or scattered randomly across the body,” she says. And finally, DPN: “By comparison, DPN spots are dark, consistently pigmented, and almost always found in clusters. They sit on the surface of the skin and follow a characteristic pattern on the face.”
What causes DPN?
For years, I was convinced my smattering of brown spots were age- and sun-related. As it turns out, they appeared around the same time DPN commonly begins to develop — though I’ll probably never know whether my years spent living in sunny Florida influenced how many showed up. What dermatologists do know is that genetics plays the biggest role. “If your parents or grandparents have it, there is a high likelihood you will too,” Dr. Humphrey explains.
As for my own case? UV exposure may not be completely off the table. “Sun exposure likely plays a role in how many spots develop and how quickly, but it doesn’t cause DPN on its own,” says Dr. Humphrey. Good to know — and an important reminder to never sleep on sun safety.
How do you treat DPN?
I’d made the grave error years ago trying to scrape and pick them off; learn from my mistakes and don’t try this at home! Unfortunately, DPN doesn’t respond to topical treatments like vitamin C, exfoliating acids, or retinoids, so if you’re interested in removal, an in-office procedure is your best bet.
According to Dr. Humphrey, treatment options include electrodesiccation (using a tiny electric needle to zap each spot), curettage (gently scraping them away), laser treatments, cryotherapy (freezing the spots with liquid nitrogen), or simple snip removal with surgical scissors. “Of these, the electric needle method and certain lasers tend to work best for darker skin tones because they allow the most precision with minimal trauma to surrounding skin,” she explains.
@dr.ugonabo Stitch with @terruhashi explaining DPNs. In short, harmless but they do bother some people so we can remove them. #dpns #dpnremoval #dermatosispapulosanigra #dermatologist #moleremoval ♬ original sound – Dr. Ugonabo – Dermatologist
As with most cosmetic dermatology procedures, DPN removal isn’t cheap, and since it’s considered a cosmetic procedure, it’s not typically covered by insurance. Expect to pay anywhere from $250 to $1,000 per session, depending on the number of spots being treated and your provider.
Are there any risks to DPN removal?
Any of the professional removal methods listed above are generally very safe, but there are a few rare risks to keep in mind, especially for darker skin tones.
Per Dr. Humphrey, post-inflammatory hyperpigmentation is the most common complication she sees in patients. “The skin responds to irritation by producing extra pigment, [sometimes] leaving a dark mark where the spot was removed,” she says. In some cases, the opposite can happen, where the treated area loses pigment and looks lighter than the surrounding skin.
People with deeper skin tones may also have a higher risk of scarring or keloids — raised, thickened scar tissue that can form at the treatment site. (Keloids are also commonly seen with certain body piercings.) None of this should discourage anyone from seeking treatment for DPN, though, if you want to. “These risks are real, but a skilled provider who regularly treats patients with melanated skin will know how to minimize them,” Dr. Humphrey says.
@drjennyliu Your wisdom spots!! I love electrocautry treatment for skin of color to avoid PIH #dermatology #dermatosispapulosanigra #skintag #skintageremoval #warts #skincaretiktok #dermatologist #skintok #dermtok ♬ New Flame (but I promise you) (feat. Usher & Rick Ross) – Chris Brown
One last thing to know: treatment removes the spots you already have, but new ones can still develop over time. “There’s no way to prevent that, and it’s not a sign that anything went wrong — it’s just how DPN works,” Dr. Humphrey says. “Think of it less as a one-time fix and more as ongoing maintenance, similar to how you might manage other skin concerns over time.”
As with moles and birthmarks, any changes in shape, size, or color are a good reason to book an appointment with a trusted dermatologist. “DPN is completely harmless from a medical standpoint, but there are situations where you should get a spot checked by a board-certified dermatologist,” Dr. Humphrey says. Those include if a spot bleeds without being scratched or irritated, or if it looks noticeably different from other spots on your body.
Final Thoughts
DPN isn’t something I necessarily thought about every day, but learning what it actually is has definitely shifted how I see my skin. What once felt like a mystery at best and a stubborn game of Whack-A-Mole at worst — is just a common condition in skin of color, like mine. I’m also aware that my DPNs are relatively small and mostly confined to my temples and back — but it was still something that stood out every time I looked at my skin in the mirror. And like so many beauty concerns, the choice to treat it or not ultimately comes down to personal preference, not medical necessity.
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