Seborrheic Keratosis, DPN and Age Spots: Harmless or Not?

Seborrheic keratoses are very common, harmless brown or black growths that look warty or stuck on and appear more as we age, and dermatosis papulosa nigra (DPN) is a closely related form of small dark bumps on the face and neck that is especially common in Indian skin. Neither is cancer, but because some skin cancers can look similar, any spot that is new, changing, bleeding or different from your others should be checked by a dermatologist.

Many people in India describe these as moles, warts, til or age spots. Knowing what they are can save a lot of worry, and also help you notice when a spot behaves differently.

What is a seborrheic keratosis?

A seborrheic keratosis is a benign (non cancerous) growth of the outer layer of skin. They are among the most common skin growths in adults.

Typical features:

• Raised, warty or waxy surface, often looking stuck on, like a blob of wax or clay that could be lifted off
• Light brown, dark brown or black
• Round or oval, from a few millimetres to a couple of centimetres
• Rough or slightly greasy to touch
• Common on the chest, back, belly, face, neck and scalp, but can appear anywhere except palms and soles
• Usually painless, but may itch, catch on clothes or jewellery, or become irritated and bleed

They usually start after the age of 30 to 40 and increase in number over the years. They tend to run in families. Despite the name, they are not related to seborrheic dermatitis or dandruff.

What is dermatosis papulosa nigra (DPN)?

DPN is considered a variant of seborrheic keratosis seen mainly in people with brown and black skin. In India, it is very common, especially in women.

Typical features:

• Many small, smooth, dark brown or black bumps, often 1 to 5 millimetres
• On the cheeks, around the eyes, forehead and neck
• Gradually increase in number and size with age
• Often run in families
• Usually painless, though they may itch or catch on clothes

DPN is harmless, but many people find the bumps affect their appearance and wish to have them treated.

What are age spots (solar lentigines)?

Solar lentigines, often called age spots, sun spots or liver spots, are different:

• Flat, not raised
• Light to dark brown, with clear edges
• Appear on sun exposed areas such as the face, backs of hands, forearms and shoulders
• Caused by years of sun exposure, more common with age

Some lentigines can thicken over time and turn into a seborrheic keratosis. Daily sun protection helps reduce new spots. Our sunscreen guide for India covers choosing the right SPF and PA rating.

How can I tell these spots apart?

Feature	Seborrheic keratosis	DPN	Solar lentigo (age spot)	Mole (naevus)
Surface	Raised, warty, stuck on	Small, smooth raised bumps	Flat	Flat or raised, smooth
Colour	Light brown to black	Dark brown to black	Light to dark brown	Brown to black, even
Usual site	Trunk, face, scalp	Cheeks, around eyes, neck	Sun exposed areas	Anywhere
Usual age of onset	30 to 40 and older	Adulthood	Middle age onward	Childhood to young adulthood
Cancer risk	Benign	Benign	Benign	Most benign, a few change

These patterns are only a guide. A dermatologist may use a dermatoscope, a handheld magnifying light, to look closely at the structure of a spot. If there is any doubt, a small biopsy may be advised.

Flat brown patches on the cheeks that come and go with the sun may be melasma rather than age spots. See our guide on melasma treatment for Indian skin. Dark marks left after acne or rashes are covered in our article on post inflammatory hyperpigmentation.

When could a dark spot be something more serious?

Skin cancer is less common in Indian skin than in fair skin, but it does occur, and melanoma in brown skin is often found on the palms, soles and under the nails. Watch for:

• A new spot that looks different from your others (the ugly duckling sign)
• Change in size, shape or colour
• Irregular or blurred borders, or several colours in one spot
• Bleeding, crusting or a sore that does not heal
• A dark streak in a nail, or a dark spot on the palm or sole that is growing
• Sudden appearance of many seborrheic keratoses over a short time, which is rare but should be checked

If you notice any of these, see a dermatologist rather than trying to remove the spot.

How are seborrheic keratoses and DPN treated?

Treatment is not medically necessary, because these growths are harmless. People usually choose treatment because the spots itch, catch on clothes or jewellery, bleed, or affect appearance.

Your dermatologist may consider:

• Electrocautery or radiofrequency, a common and quick method for DPN and small keratoses
• Cryotherapy (freezing), used cautiously on brown skin because it can leave light patches
• Curettage, gently scraping off the growth
• Laser treatment for selected spots
• Topical treatments in some cases, though results for raised growths are limited

Points to know on Indian skin:

• There is a risk of temporary dark or light marks after treatment, which usually fade over weeks to months.
• Sun protection after treatment helps reduce dark marks.
• Treating a few spots in a test session first may be suggested.
• New spots can appear over time, so repeat sessions may be needed in future.

Treatment costs in India vary with the number of spots and the method used.

Can I remove these spots at home?

Please avoid it. Common home attempts in India, such as cutting with blades or nail clippers, tying a thread, using caustic pastes, acids or so called mole removal creams, can lead to:

• Bleeding, infection and painful wounds
• Scars and dark marks that are more noticeable than the original spot
• Missing a skin cancer that needed proper diagnosis

The same applies to soft hanging growths in the neck and underarms, which are usually skin tags. Our guide to milia, whiteheads and skin tags explains these.

Can I prevent seborrheic keratoses?

There is no proven way to prevent seborrheic keratoses or DPN, as they are largely genetic and related to age. Daily sunscreen, protective clothing and shade may help reduce sun related spots like solar lentigines. Avoid harsh scrubs, bleaching creams and steroid creams on dark spots, as these do not remove raised growths and can cause new problems. Our article on topical steroid misuse explains why.

When to see a dermatologist

See a dermatologist if:

• A spot is new, growing quickly, changing shape or colour, or looks different from the rest.
• A growth bleeds, crusts, itches persistently or does not heal.
• Many new spots appear suddenly.
• You have a dark streak in a nail, or a growing dark spot on a palm or sole.
• You would like spots treated safely, with minimal marks.

Dr. Maria offers online consultations where you can share photos of your spots for an initial assessment, and she can advise whether they look harmless, need an in person check, or could be treated.