Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Class Summary

Isotretinoin has been used for sebaceous hyperplasia because of its ability to temporarily shrink sebaceous glands. Lesions return after discontinuation of therapy. Consider only for the most severe disfiguring cases in men or women who cannot become pregnant. Should only be prescribed by dermatologic experts in oral retinoid therapy.

Isotretinoin (Amnesteem, Claravis, Myorisan, Sotret)

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Isotretinoin is a synthetic 13-cis isomer of naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A.

It decreases sebaceous gland size and sebum production and may inhibit sebaceous gland differentiation and abnormal keratinization. Isotretinoin is used initially for severe cystic/scarring acne. Because of its action in reducing sebaceous gland size, it is used in sebaceous hyperplasia in lower doses than in acne.

The optimal dose and duration used to treat sebaceous hyperplasia not established. Clearance has been achieved within 2 weeks in some patients. Others may take longer. Recurrence within 1 month after stopping is common.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

Questions

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Media Gallery

Normal sebaceous gland histology. Courtesy of Cooper Heard, MD.
Histology of sebaceous hyperplasia; enlarged sebaceous gland with multiple lobules grouped around a central dilated sebaceous duct. Courtesy of Cooper Heard, MD.
Typical distribution of sebaceous hyperplasia on the forehead in a middle-aged male.
Close-up of typical sebaceous hyperplasia on the face (red arrows).
Juxtaclavicular beaded lines, a variant of sebaceous hyperplasia, in an elderly man.
Close-up of facial sebaceous hyperplasia.

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Author

David T Robles, MD, PhD, FAAD Dermatologist, Oak Tree Dermatology

David T Robles, MD, PhD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Kristin Mickelson, PA-C Dermatology Physician Assistant, Chaparral Medical Group

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology Association

Disclosure: Nothing to disclose.

Stephen H Mason, MD

Stephen H Mason, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery, Women's Dermatologic Society, Skin Cancer Foundation

Disclosure: Nothing to disclose.

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

R Walker Jones, MD Harris M Blackman, MD, LLC

R Walker Jones, MD is a member of the following medical societies: American Chemical Society, American Medical Association, American Medical Student Association/Foundation, and Louisiana State Medical Society

Disclosure: Nothing to disclose.