Women’s Health Week: Those Spots Aren’t Freckles, But Rather, Dermatosis Papulosa Nigra

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It wasn’t until I chatted with a doctor about hyperpigmentation and skin issues that I realized the spots I thought were cute freckles on my fiancé and father-in-law’s faces are not freckles whatsoever.

You’ve probably seen them on a family member, or maybe you have them, but flesh moles are quite common. According to Amy McMichael, MD, professor and chair of the Department of Dermatology at Wake Forest Baptist Medical Center, they are the “layperson’s term for skin tags or seborrheic keratoses. These lesions occur in people of all ethnicities, but usually only in adults over the age of 30.”

They are the small marks that pop up due to pigment-producing cells in the skin, and according to John Hopkins Medicine, they can be flat or raised, smooth or rough, and hairy or hairless. Seborrheic keratoses may also be round or oval. Flesh moles can range in color from flesh-colored to brown or black–and sometimes yellowish. And according to doctors, they’re harmless, benign spots.

But when they are dark and occur on a man or woman of African descent, it goes from being called a simple flesh mole to being called dermatosis papulosa nigra. (Yes, “nigra” as in dark colored…or black.) According to the American Osteopathic College of Dermatology, “These first appear during teen years, slowly becoming more pronounced as one ages. This is fairly common in blacks, present in about one third of adults. Occasionally this may also appear on white and oriental skin.”

You might see them on your upper cheeks, but they’re also prevalent on the neck, chest and back. As previously mentioned, these lesions are most often benign. However, they can become irritated, and such discomfort is often the reason behind people’s decision to have them removed. But if you find that these flesh moles have grown larger with time, McMichael says that you shouldn’t freak out. It’s common.

“They do not become cancerous and are merely a cosmetic issue, though some lesions can become irritated and require removal for this reason. These lesions can and do grow naturally with advancing age.”

And while many people proudly let their moles stand out, including dignitaries and stars like Condoleeza Rice and Morgan Freeman, some people opt to have them removed for cosmetic reasons.

“One can have them removed cosmetically by your dermatologist,” McMichael said, “but be ready to pay out of pocket for this as this procedure is not typically covered by insurance. Usually, the dermatologist will numb the lesions and remove them with an electric needle or small scissors.”

Other removal options also include cryosurgery. But whatever treatment you go for, according to experts, you should be aware that the darker your skin, the more likely you are to end up with pigmented scars. Therefore, the removal of these moles should be preceded by testing a few of them at a time, and should be done carefully in the hopes of preventing scarring from happening.

All in all, there isn’t a way to prevent them. According to DermNet NZ, around 40 to 50 percent of patients with the condition have people in their family with it, making it genetically determined. And according to Charles E. Crutchfield III, MD in a post for MSR News, dermatosis papulosa nigra seems to happen more often in women than men. Plenty of people have this particular type of mole and look just fine. But if you’re interested in removing them for whatever reason, including because of enlargement as you get older, speak with your dermatologist about possible treatment options to find one that best fits your condition and will provide you with the results you’re looking for. If not, I say, continue to embrace them.


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