That Which We Call A Freckle Is Not A Freckle?

October 3, 2016

Earlier this year, I got my first cosmetic treatment done on my face. It was no biggie, I just got some freckles removed.

These weren’t ordinary freckles though. They were tiny, dark spots that were raised. As in, whenever I turned my face to the side, I could just about make out that they were tiny bumps. I could also feel they had a lumpy texture.

Most likely they were harmless. But still, l wanted them gone. Because why not?

Dark Spots - Dermatosis Papulosa Nigra (DPN)

My skin before the treatment. See the dark spots? They’re called Dermatosis Papulosa Nigra (DPN). Morgan Freeman has them too.

I learned that these freckles are called Dermatosis Papulosa Nigra (DPN), a harmless and common skin condition.

I then had a dermatological treatment done to remove them.

It’s been a while since I had the treatment done (seven months), but I’ve been meaning to share my experience and results on the blog.

Reader be warned: this post gets human body graphical. Like graphic and extreme closeup photos of my skin.

Read on if you’re curious.


When I turned 29, I started getting these very small, dark, freckles on the side of my face. They popped up over and around my cheeks, cheek bones and temples.

There were only a few at first. I thought they were just regular freckles. The result of hyper pigmentation, too much time in the sun, a bit of stress and a healthy dose of aging. Which was fine. Then a few more popped up, especially along the left side of my face. And actually, some of them sloughed off on their own.

But as I started getting over that new decade called my 30s, more and more kept popping up. And this time, they were no longer going away on their own.

Then last October 2015, my HMO (Kaiser Permanente) was giving out free consultations with a licensed esthetician. Of course I jumped on it. I went there specifically with the intent of getting rid of the tiny dark spots.

The esthetician took a long, close look at my skin under a large magnifying glass and said something about a keratosis.

She said it was probably hereditary. But since there were more of them on the left side of my face, my driver’s side, she suggested that these may also have been sun induced.

That surprised me because I really didn’t think I drive that much. But that goes to show you the power of the sun. Sun protection, people. It’s for real.


So off I went to the dermatologist. That’s where I learned that the freckles on my face are Dermatosis Papulosa Nigra, which are raised skin lesions called papules.

DPN is a type of seborrhoeic keratosis, which are very common and harmless, often pigmented growths on the skin.

According to a patient information leaflet by the British Association of Dermatologists (BAD):

Seborrhoeic keratoses have a rough surface, and range in color from golden brown to mid brown to almost black. They can affect anyone, but on dark skinned people they can also appear as multiple small dark brown or black bumps, especially on the face and the neck; in such a case this is called Dermatosis Papulosa Nigra. (Source: here)

According to BAD, most cases of seborrhoeic keratoses need no treatment as they are harmless and cause no symptoms. They are benign growths due to a build up of ordinary skin cells.

I’m curious to know why these ordinary skin cells stop turning over.

The BAD leaflet goes on to say that it is related to exposure to sunlight. And that the tendency to have a higher number of seborrhoeic keratoses can run in families.

1) The esthetician’s explanation about developing more freckles on the left side of my face because it’s my driver’s side
2) The information from BAD’s leaflet
3) AND the picture below of an old truck driver whose left side of the face (his driver’s side) is shockingly more aged due to 28 years of sun exposure

My guess is that, in addition to my having a genetic propensity to develop these dark, raised spots, the sun must also have played a part in damaging my skin and triggering the formation of DPN.

Sun Damage

The effects of the sun. This truck driver’s left side was exposed to the sun for years.


The dermatologist used cryotherapy to remove the spots, which involved pricking my face with a needle and liquid nitrogen.

The process stung and burned. It wasn’t unbearable, it was simply intense pain in the tiniest concentration. I got squeamish when she began treating spots right near my eyes!

It was a quick process that lasted no more than 5-10 minutes. In total, about 15 spots were treated.

Then I began to bombard the dermatologist with questions about how to care for my skin.


I was told to care for my skin in the following way:

  • Treat it like it’s an open wound.
  • Keep it clean.
  • Don’t pick or scratch at it. Otherwise it could get infected and lead to scars.
  • Protect the skin from the sun.
  • Don’t use acids, like glycolic or salicylic acids.

The dermatologist also warned me that there was a low risk of the treatment resulting in skin discoloration.

To speed up healing, I was given a tiny tube of Aquaphor, a goopy vaseline-based ointment.

Aquaphor Healing Ointment


Immediately afterwards, my skin was burning! The treated spots looked red and raw.

Skin after cryotherapy treatment of Dermatosis Papulosa Nigra

The car ride right after the cryotherapy treatment. My skin looked and felt red and raw.

The next day was even worse. The spots looked darker and bigger due to the blood beginning to clot.

Fortunately, I got the treatment done on a Friday. Which meant I could spend the rest of the weekend hiding my face from the world.

2 days after cryotherapy

2 days after cryotherapy, the spots had begun to heal.

Everyday I kept an eye on all the treated spots, waiting for something to happen. What actually was supposed to happen next!? Would the spots start to fall off? How many days would it take? Was it actually going to work? I was full of questions and misgivings.

On day 3, I noticed that one spot was just… no longer there. Gone. Pouf. Vanished.

And then a few days later, more and more began to come right off.

Finally on day 5, while I was washing my face I noticed that a few more had come off. I then began to gently slough off most, if not all, of the spots.

Et voilà, my skin was noticeably improved.

Results after cryotherapy

My skin after the treatment.


The treatment worked!

Afterwards, to my great pleasure my skin tone was more smooth and even. Most of the DPN spots were gone.

Before Cryotherapy Treatment for Dermatosis Papulosa Nigra - Closeup

Closeup – Before treatment.

After Cryotherapy Treatment for Dermatosis Papulosa Nigra - Closeup

Closeup – After treatment. Can you tell a difference?

Only one large and prominent freckle remained (left center in the photo above). This one the dermatologist refused to treat because it actually turned out to be a REAL freckle.

As to why cryotherapy does not work on regular freckles? I have no idea.


Three months after the treatment, I began to notice that new, small and very faint spots had begun to come up in the same place where the old spots had been. Only a few so far though. I’m sure as I get older I will get more of these same spots.

Depending on how quickly they pop up, I may consider getting this treatment done again.

I know that these spots on my face are simply a testament of living my life.

So while I’m open to small and subtle touch ups to enhance my natural features, I do not have this desperate compulsion to erase every single trace of time’s passage on my face.

So that, ladies and folks, is how I hope to age with grace 🙂

3 thoughts on “That Which We Call A Freckle Is Not A Freckle?

  1. Rae

    I have a lot of these. A dermatologist said they’re flat warts, but mine aren’t flat, they look a lot like your bumps. I should get a 2nd opinion before I go to the scheduled cautery session.

    1. Kareen

      Definitely get a second opinion if you can. Also, feel free to send me (kareen[at] a closeup photo of your freckles. Seriously! I am not a dermatologist but I can let you know if it looks similar to what I have 🙂

  2. Frenchie au Canada

    When you talked about the left side I immediately remembered seeing those photos of truck drivers. I have a couple of similar spots on the left side of my face but they are so tiny they are barely visible.
    Your skin look amazing and you can really see a difference, it’s great 🙂


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