Small dark bumps on the cheeks (DPN): harmless and removable

Key takeaways

• DPN is a harmless growth of the top layer of skin, a small cousin of the "seborrhoeic keratosis" that many older people get.
• It is far more common in darker skin types, which includes most Indian skin, and it usually runs in the family.
• The bumps tend to increase in number and size with age. Nothing you did caused them.
• Removal is optional. When it is done, it should be superficial, because aggressive methods can leave light or dark marks in brown skin.
• Any spot that is changing fast, bleeding or looks different from the rest needs a doctor's look first, not removal.

What exactly are these little dark bumps?

In my clinic, a very common request goes like this: "Doctor, these black dots on my cheeks keep increasing. My mother has them too. Can you just burn them off?" Normally, when I look, they are DPN.

DPN stands for dermatosis papulosa nigra. Basically, these are tiny benign growths of the outer skin, usually 1 to 5 mm across. They are firm, smooth, dark brown to black, and some hang on a little stalk. DermNet describes them as a variant of seborrhoeic keratosis, the "stuck on" brown spots of older skin, seen mainly in darker skin types.

They sit on the cheekbones, around the eyes, on the temples and forehead, and on the neck. Sometimes they spread to the upper chest and back. They do not itch, scale or ulcerate. They are not contagious, they are not warts, and they are not cancer.

Why do they appear, and why do they keep increasing?

See, what happens is, this is largely genetic. DermNet notes that 40 to 50 percent of people with DPN have a family history, and one study summarised in the journal Cutis found that most patients had a first-degree relative with the same bumps. Women are affected more often than men.

They usually start in the teens or twenties and slowly increase in number and size with age. So if you are in your thirties and noticing more of them each year, that fits the normal pattern. Sun exposure is not the main cause, but they do tend to sit on sun-exposed parts of the face.

Two things they are not caused by: dirty skin or the wrong face wash. No cream or home remedy will make them fall off. I would ask you not to pick at them, scratch them or try to cut them with anything at home. That is how a harmless bump becomes an infected sore and then a dark mark.

Is it DPN, a mole, a wart or a skin tag?

These four get mixed up all the time. A quick comparison helps, but the final word should come from someone examining your skin, ideally with a dermatoscope (a lighted magnifier).

If one spot looks different from the others, is growing quickly, has uneven colour or bleeds, that is a different conversation. Please read my article on moles and when to get one checked and get it seen promptly. DermNet also points out that, rarely, a sudden crop of many seborrhoeic keratosis type spots can signal an internal problem, which is another reason a doctor should look before anything is removed.

How are DPN bumps removed?

Removal is a choice, not a medical need. DermNet actually says these are generally best left alone. That is very important to understand. I will happily remove them if they bother you, but I want you to know the trade-off in brown skin first.

The methods described in the medical literature include: - Light electrodesiccation (electrocautery or radiofrequency): a fine tip touches the bump and dries it at the surface. This is the most common approach. A numbing cream is used first. - Curettage or fine scissor snip: the bump is gently scraped or snipped off at skin level. - Laser: certain lasers have been reported to give good cosmetic results. In studies, laser was not clearly better than electrodesiccation and some patients found it more uncomfortable. - Cryotherapy (freezing): generally avoided in DPN on brown skin, because it can leave pale patches.

The key word is superficial. The aim is to take off only the raised part and leave the skin underneath alone. Going deeper does not make the result better. It only raises the chance of a light patch, a dark patch or a small scar. In darker skin, keloid scarring is also a risk in people prone to it, so tell me if you or your family form thick scars.

What does recovery look like?

Normally, each treated spot forms a tiny dark crust that falls off by itself in about a week. Here is what I usually tell people: 1. Keep the area clean and apply the ointment you are given. Wound care with petrolatum or antibiotic ointment helped healing in at least one study. 2. Do not pick the crusts. Let them fall. 3. Use sunscreen every morning once the crusts are off. Brown skin tends to darken after any injury, and this is called post-inflammatory hyperpigmentation. My article on dark marks after pimples explains why. 4. Expect some pinkness or slight darkness for a few weeks. It usually settles. Ingredients like niacinamide and azelaic acid are sometimes suggested to help. 5. New bumps will appear over the years, because the tendency is genetic. Many people choose a small touch-up session every year or two.

If you have dozens of bumps, I prefer doing a test patch of a few first, then the rest in one or two sittings. That way we both see how your skin heals before committing.

How we approach this at Dr Tvacha

Removal of unwanted growths such as skin tags, warts and DPN is part of our skin work at the Thane, Andheri, Bandra and Dahisar centres. Under the Second Layer Skin Plan, I first confirm what each bump is, check anything that looks unusual, and then quote the removal in writing before you decide. If a spot needs a closer look rather than removal, I will tell you that plainly. For other growths, see my article on skin tags.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.