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What can be the cause of tiny black spots on my daughter's face?

Q: My 8-year-old daughter has started to get tiny black spots on her face (cheeks area near the eyes). A skin specialist said that these are warts caused by infections and will spread to other parts. She prescribed Duofilm (supposed to be acidic in nature) and advised that the lotion has to be applied on the wart carefully by tooth pick and within a couple of days the wart will burn and fly off. We tried this on our daughters neck area. After 7 days the spot became brown and came off leaving a white mark. We were scared to continue this treatment on the face. We consulted another senior skin specialist who ruled out the possibility of warts and diagnosed it as freckles, which are harmless and can be controlled by use of sun block cream etc. basically avoiding the sun. We are totally confused with the 2 different opinions. What should we do to control and clean these black spots from my daughters face?

A:You did the right thing by not applying the Duofilm (a caustic agent) on the face. Facial lesions whatever they are need to be treated under strict supervision. Without clinical photograph or clinical examination, I can only speculate on various possibilities. Freckles are usually numerous in number on the face and are in different shades of black colour with irregular margins. They become darker on sun exposure, hence photo protection with sunscreens is advised. Lentigenes is another close possibility, but these lesions are uniformly dark, well demarcated, generally many in number. These lesions are flat lesions and are not raised above the skin. Dermatosis papulosa nigra is another possibility in young persons. Of course warts especially pigmented plane warts can be confused with them. Both these conditions produce slightly raised skin lesions. In case of doubt, a skin biopsy can settle the diagnosis. With these facts in your mind, you may consult any other dermatologist.

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