Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Retinoid-like Agents
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)
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.
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Normal sebaceous gland histology. Courtesy of Cooper Heard, MD.
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Histology of sebaceous hyperplasia; enlarged sebaceous gland with multiple lobules grouped around a central dilated sebaceous duct. Courtesy of Cooper Heard, MD.
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Typical distribution of sebaceous hyperplasia on the forehead in a middle-aged male.
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Close-up of typical sebaceous hyperplasia on the face (red arrows).
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Juxtaclavicular beaded lines, a variant of sebaceous hyperplasia, in an elderly man.
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Close-up of facial sebaceous hyperplasia.