A common skin condition among people of color goes misdiagnosed for years. Here’s what it is, why it forms, and what removal actually involves.

For years, those small dark spots along my cheekbones registered as background noise. Acne scars, maybe. Sun damage, possibly. It took a conversation with dermatologist Dr. Victoria Humphrey at the American Academy of Dermatology’s annual meeting to put a name to them: Dermatosis papulosa nigra, a benign skin condition that affects a significant portion of people with darker complexions.

That name meant nothing to me at first. Once she explained it, a lot of things clicked.

What dermatosis papulosa nigra actually is

Dermatosis papulosa nigra shows up most often in people’s late 20s and early 30s as small, raised, consistently pigmented spots. They tend to cluster on the cheeks, eyelids, and temples, though they can also appear on the neck, chest, shoulders, and upper back. Dr. Humphrey noted that some people recognize the condition more easily when they think of Morgan Freeman’s distinctive facial spots.

What makes Dermatosis papulosa nigra tricky is how easily it gets misread. It shares visual territory with hyperpigmentation, moles, and skin tags, but it’s none of those things. Skin tags are soft and fleshy. Moles grow from deeper skin layers and can be flat or raised. DPN spots are uniformly dark, raised, and almost always grouped together.

Why genetics, not the sun, drives DPN

I spent years assuming my spots were sun-related. Turns out, the more accurate explanation is written into DNA. If a parent or grandparent has Dermatosis papulosa nigra, there is a strong likelihood the next generation will develop it too. UV exposure can influence how many spots appear over time, but it is not the root cause.

That distinction matters. No amount of SPF will prevent Dermatosis papulosa nigra from forming if it is already in your genetic profile. Sun protection is still worth maintaining, but expecting it to stop Dermatosis papulosa nigra is a different conversation.

Topical products won’t touch these spots

This is the part that surprised me most. After spending years testing serums, I learned that topical treatments including vitamin C and retinoids have no effect on Dermatosis papulosa nigra. The spots simply do not respond to them. If removal is the goal, in-office procedures are the only path that works.

Options include electrodesiccation, which uses a small electric needle on each spot; curettage, a gentle scraping method; laser treatments; cryotherapy with liquid nitrogen; and snip removal using surgical scissors. Dr. Humphrey pointed to electrodesiccation and certain laser treatments as particularly effective for darker skin tones, since they minimize trauma to the surrounding area.

The costs and the risks worth knowing

DPN removal is categorized as a cosmetic procedure, which means insurance typically does not cover it. Costs per session generally fall somewhere between $250 and $1,000.

Beyond cost, there are risks that deserve serious consideration, particularly for people with deeper skin tones. Post-inflammatory hyperpigmentation is the most common complication, where the skin responds to irritation by producing extra pigment and leaving a darker mark in the treated area. Hypopigmentation is also possible, where the treated skin loses pigment and appears lighter than the surrounding tone. People with deeper skin tones also carry a higher risk of scarring or keloids.

A skilled, experienced provider significantly reduces these risks. The other thing worth understanding is that removal addresses existing spots only. New ones can form over time, which means ongoing treatment may be part of the picture.

A condition common enough to deserve more awareness

DPN affects a meaningful portion of people with darker skin and remains widely misunderstood, partly because it is benign and partly because it gets lumped in with other conditions. Deciding whether to pursue treatment is personal. There is no medical urgency attached to Dermatosis papulosa nigra, and for many people the spots remain small and stable. Anyone noticing changes, particularly spots that bleed or look different from the others, should check in with a board-certified dermatologist.

Understanding what is on your skin is rarely a bad starting point.