SK AND SKIN OF COLOR
Seborrheic Keratosis Affects All Skin Types
Many African Americans and other dark-skinned people have multiple seborrheic keratosis lesions. SKs in dark-skinned patients look the same as SK in light-skinned patients under the microscope. However, facial seborrheic keratosis lesions in African Americans are typically darker, more abundant, smaller in size (generally 1 to 5 mm) and higher than they are wide. Since these lesions on the face appear different visually, they are referred to as dermatosis papulosa nigra (DPN) rather than seborrheic keratosis.
“They can look like little stalks sticking up from the skin,” says Mary Lupo, M.D., a dermatologist in private practice at the Lupo Center for Aesthetic and General Dermatology in New Orleans and clinical professor of dermatology at Tulane University School of Medicine.
“Because the lesions tend to show up on the face, especially on the upper cheeks and near the eyes, many patients worry that they are looking older or ‘turning into their mother’,” says Dr. Lupo. Indeed, there is a stronger family history, and a younger onset, associated with DPN than with other types of SK. According to a 2013 review in the American Family Physician, more than 50% of patients reported having other family members affected.
“The challenge in treatment,” says Dr. Lupo, “is not to exchange one problem for another, such as a scar or white spot (hypopigmentation). You don’t want to make them look worse instead of better,” she says. That’s why she and other doctors avoid the use of cryosurgery, which carries those risks in dark-skinned people.
Rather than freezing the lesions, dermatologists will use heat to remove the lesions of dark-skinned patients. The procedure is referred to as electrodesiccation and involves the use of an electric needle to burn off the DPN. Topical anesthesia is used before the procedure to reduce the pain felt by the patient. This procedure can be time-intensive but avoids permanent hypopigmentation or scarring that are the main risks of using cryotherapy.
Some dermatologists have reported success in treating DPN with a variety of lasers. Laser treatments do typically achieve good cosmetic results, but repeat treatments are usually necessary to remove the lesions successfully. Hyperpigmentation is a possible complication.
Other dermatologists prefer to use curettage to remove DPN. A local anesthetic is injected into the skin before the procedure. Then a metal hand tool with a small scoop at the tip, called a curette, is used to scrape off the lesion.
Like other seborrheic keratosis sufferers, someone with DPN will grow lesions in new spots after receiving treatment and might find that she wants to see her dermatologist every year or two to have new lesions removed.