Electrosurgery in dermatosis papulosa nigra: An effective, well-tolerated but less documented tool

Abstract

Dermatosis papulosa nigra (DPN) is a superficial, black or brown benign papule that develops mainly in dark-skinned individuals over the face and neck. Clinically seborrheic keratosis shows a stuck-on appearance that differentiates it from DPN. Histopathological examination described that both were identical. Many types of lasers are used as treatments for it. Traditional surgical procedures such as curettage, electrosurgery, and snip/shave excision are still considered as a therapeutic modality. Although electrodessication (ED) is a simple procedure, studies on ED use for DPN with a good number of cases are lacking. This paper presents the evaluation safety, efficacy and cost-effectiveness of ED for the treatment of DPN in Fitzpatrick’s skin type IV to VI. A total of 40 patients (11 male and 29 female) with DPN over the face and neck with skin type IV–VI were included. Superficial ED (monopolar, low, 2–3.5 W) was done by just touching the lesion under topical anesthesia. All preoperative photographs as well as 2-, 4- and 8-week post-procedure photographs were examined by two independent dermatologists who had no prior information concerning the procedure, (both known hereafter as “blinded observer”): one for examining efficacy in terms of poor improvement (0%–25%), fair (26%–50%), good (51%–75%), or excellent (76%–100%), by counting completely cleared lesions; and the other for examining side effects in terms of hypo/hyperpigmentation and scarring. As a result, 85% of patients showed excellent improvement (>75% clearance), 7.5% good (51%–75% clearance), 5% fair (26%–50% clearance) and 2% poor (0–25% clearance) as measured by the “blinded” observer. Post-inflammatory hyperpigmentation was observed in 15% cases, whereas hypo-pigmentation was documented in 7.5% cases. Only in two cases (5%) was lesional scarring noted. Those complications were cleared after eight weeks. In this study, ED was observed to be an effective, well-tolerated and cost-effective method for treatment of DPN in colored skin. Complications were few, and therapy was performed appropriately with effective postoperative measures.