Turns Out Those “Black Girl Freckles” Are Actually Dermatosis Papulosa Nigra

Today, I counted 52 freckles on my face. Four more than last time. As someone who has taken more than a few selfies in my lifetime, I have spent more time closely inspecting my face than is perhaps considered healthy. But, this time I have a good reason. Similarly to freckles caused by exposure to sunlight and genetics, the small, splattering of small dark brown marks across my cheeks and temples came in gradually, in my early 20s, and grew more prominent after I went on holiday and I wasn’t as liberal with sunscreen as I should be. And, if you look more closely, these raised lesions across my face are not “freckles” at all. 
I’ve heard a few names for them over the years:  “beauty marks,” moles, sun spots and — via strangers who’ve commented on my pictures online — “Black girl freckles.”I didn’t know that they had an actual medical term until a random Google search for ‘those moles Black people get’ came up with the term dermatosis papulosa nigra (DPN). These skin lesions are most prominent in Black, Asian and Indigenous skin types, and most notably are the distinguishable features of actor Morgan Freeman.
In an even deeper dive into DPN online, I found content creator Lesley Buckle, otherwise known as Fresh Lengths on social media, who got her DPN removed using Electro Surgery in 2016. For a long time, she was my only reference (other than Morgan Freeman) who has talked about the skin condition, period. “I first noticed I had them as a teenager,” she tells Unbothered. “They can start developing around puberty. At first, they were small lumps but by the time I was 16 they were big clusters on my face, particularly around my cheeks and jaw. I had a lot on my neck and a few on my body too but it was the ones on my face that seemed to bother me. I think I started looking into removal as I was a little embarrassed when I was younger.”
“I didn’t know anyone around my age that had them, the only examples I knew were people that were older. My mum has DPN and her whole face was covered in them when I was younger and then there were older famous figures like Morgan Freeman,” Buckle shares. “My mum didn’t know much about them either and my dad had told me how they’d grown since he knew her (possibly after pregnancy). I thought that eventually my face would be covered in DPN too so that’s when I started looking into how to get them removed.”
Like Buckle, I’m becoming increasingly aware that DPN freckles can grow more prominent over time and appear at different points on the face. I don’t mind the ones on my face right now, but I really don’t want any more. So, should I get my ”Black girl freckles” removed? I asked dermatologists and aestheticians to weigh in.

What exactly is Dermatosis Papulosa Nigra (DPN) and are they something to worry about?

“Dermatosis papulose nigra (DPN) refers to small lesions that are similar to freckles but aren’t flat on the skin,” explains Bianca Estelle, a Harley Street-trained Skin Specialist, Clinical Trainer & Director and bea skincare founder. “The lesions are more raised and are seen as a variant of seborrheic keratosis (a non-cancerous skin growth) and can be the same colour as the skin but are often darker,” the specialist explains. The London-based medical aesthetician has DPN herself and explains that the harmless skin conditions tend to run in families. “The cause is unknown, but the condition runs in families, so I’d say that it’s largely genetic,” explains Estelle.
Dr Raj Arora, GP and aesthetic skin doctor for FOREO, also explains that the skin condition is mostly seen in women and on the face and neck. “The exact cause of DPN is unknown but there is thought to be a hereditary component,” Dr Arora tells Unbothered. “Around 50% of patients seeking treatment have a family history of the skin condition. Lesions typically begin to appear around adolescence and can increase in size and number as one gets older.”

Should I be concerned about DPN?

Aside from the fact that my DPN moles will likely increase in size as I get older (sigh…), I did wonder if, like melanoma or moles that change shape, they are something to worry about. “Since the lesions are benign there generally are no medical indications to treat/remove them,” assures Dr Arora. “However, some individuals do not like the appearance of them and may want to consider having them treated/removed,” they add.

What treatments are available to remove DPN and are there any risks?

There are a number of treatments available to remove DPN, including laser treatment, cryotherapy (using liquid nitrogen to freeze off the lesions), electrocautery (using an electric current) to cauterize the lesion, and curettage (scraping) to remove the lesions. 
Bianca Estelle warns that the treatments do come with risks of scarring, hyperpigmentation and burns and it’s likely that you’ll need to have repeated treatments as more DPN appear.“It's worth noting that both the latter can cause hyperpigmentation (dark patches) or hypopigmentation (lighter patches), which can take up to six months to resolve,” she explains. “Like DPN, hyperpigmentation is also more common in those with darker skin tones so the best to consult an experienced skin specialist  before going about a route of treatment.”
Lesley Buckle opted for electrocautery at a UK clinic and has documented her results since 2016. 
“It can take a while depending on how many you have but usually numbing cream is applied beforehand so it doesn’t hurt too much,” she shares. “The clinic purposely let the skin scab over to aid better healing too so it kind of looks like you still have DPN but after about a week or two most of the scabs have healed. I had a lot of DPN by this point so I didn’t have them all removed but a lot of the larger ones were treated and I’ve been back to get more removed quite a few times since.”
“The results were incredible and worth it for me,” says Buckle. “I had downtime of maybe a week with blotchy scabby skin but once they were healed my skin was so much clearer. I’d never seen my skin like that when I was younger because I had issues with acne too so I think I knew I’d always get it done again if I needed to.”

So, should I get my DPN removed?

I’m undecided. While I’m no stranger to a facial, my face and skin have largely been untouched by aestheticians — mainly out of fear. The risks of hyperpigmentation and scarring are holding me back. 
I sent a close-up of my DPN to Bianca Estelle for her expert advice. “Cryo is an option but, unless the lesions really bother you, it wouldn’t be worth it because they are so small,” she says honestly, adding, “and using cryo means you’ll get either hyper or hypopigmentation and that will take six months to address.” Instead, Bianca Estelle recommends I use a higher grade glycolic acid and ensure I wear SPF 50 every day, keeping out of the sun where possible.
Right now, I like the way my DPN looks, especially when my partner traces them across my face and calls them cute. My father has them and so did my Grandmother, and these strangely have become an unexpected connection to my heritage, like tiny little heirlooms. As I look in the mirror I can see that I have the eyes of my mum, the nose of my dad and, sprawled across my face, proud and centre, the freckles of my late grandmother.
This article was originally published on Unbothered UK

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