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)

View full drug information

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

Hogan DJ. Sebaceous hyperplasia of the chest. Int J Dermatol. 1991 Apr. 30(4):306. [QxMD MEDLINE Link].
Krisp A, Krause W. Areolar sebaceous hyperplasia. Acta Derm Venereol. 2003. 83(1):61-2. [QxMD MEDLINE Link].
Daley TD. Intraoral sebaceous hyperplasia. Diagnostic criteria. Oral Surg Oral Med Oral Pathol. 1993 Mar. 75(3):343-7. [QxMD MEDLINE Link].
Ma HJ, Zhao G, Wang YX. Sebaceous hyperplasia of the scrotum in an adolescent boy. Pediatr Dermatol. 2007 May-Jun. 24(3):340-2. [QxMD MEDLINE Link].
Ena P, Origa D, Massarelli G. Sebaceous gland hyperplasia of the foreskin. Clin Exp Dermatol. 2009 Apr. 34(3):372-4. [QxMD MEDLINE Link].
Ju HY, Kim HS, Kim HO, Park YM. Sebaceous hyperplasia of the penile shaft. J Eur Acad Dermatol Venereol. 2009 Apr. 23(4):443-4. [QxMD MEDLINE Link].
Bakaris S, Kiran H, Kiran G. Sebaceous gland hyperplasia of the vulva. Aust N Z J Obstet Gynaecol. 2004 Feb. 44(1):75-6. [QxMD MEDLINE Link].
Malliah R, Gilhooly P, Lambert WC, Heller DS. Sebaceous hyperplasia of the vulva: case report and review of the literature. J Low Genit Tract Dis. 2006 Jan. 10(1):55-7. [QxMD MEDLINE Link].
Rocamora A, Santonja C, Vives R, Varona C. Sebaceous gland hyperplasia of the vulva: a case report. Obstet Gynecol. 1986 Sep. 68(3 Suppl):63S-65S. [QxMD MEDLINE Link].
Kato N, Yasuoka A. "Giant" senile sebaceous hyperplasia. J Dermatol. 1992 Apr. 19(4):238-41. [QxMD MEDLINE Link].
Sato T, Tanaka M. Linear sebaceous hyperplasia on the chest. Dermatol Pract Concept. 2014 Jan. 4 (1):93-5. [QxMD MEDLINE Link].
Mandal RK, Das A, Chakrabarti I, Agarwal P. Nevoid sebaceous hyperplasia mistaken as nevus sebaceous: Report of four cases. Indian J Dermatol Venereol Leprol. 2017 Mar-Apr. 83 (2):213-216. [QxMD MEDLINE Link].
Marini M, Saponaro A, Remorino L, Lynch P, Magarinos G. Eruptive lesions in a patient with bone marrow transplantation. Int J Dermatol. 2001 Feb. 40(2):133-5. [QxMD MEDLINE Link].
Salim A, Reece SM, Smith AG, et al. Sebaceous hyperplasia and skin cancer in patients undergoing renal transplant. J Am Acad Dermatol. 2006 Nov. 55(5):878-81. [QxMD MEDLINE Link].
de Berker DA, Taylor AE, Quinn AG, Simpson NB. Sebaceous hyperplasia in organ transplant recipients: shared aspects of hyperplastic and dysplastic processes?. J Am Acad Dermatol. 1996 Nov. 35(5 Pt 1):696-9. [QxMD MEDLINE Link].
Dupre A, Bonafe JL, Lamon P. Functional familial sebaceous hyperplasia of the face and premature sebaceous gland hyperplasia: a new and unique entity. J Am Acad Dermatol. 1983 Nov. 9(5):768-9. [QxMD MEDLINE Link].
Grimalt R, Ferrando J, Mascaro JM. Premature familial sebaceous hyperplasia: successful response to oral isotretinoin in three patients. J Am Acad Dermatol. 1997 Dec. 37(6):996-8. [QxMD MEDLINE Link].
Wang Q, Liu JM, Zhang YZ. Premature sebaceous hyperplasia in an adolescent boy. Pediatr Dermatol. 2011 Mar-Apr. 28(2):198-200. [QxMD MEDLINE Link].
Wilken R, Fung MA, Shi VY, Cheng MY, Patel F, Sultani H, et al. Cyclosporine-induced sebaceous hyperplasia in a hematopoetic stem cell transplant patient: delayed onset of a common adverse event. Dermatol Online J. 2016 Jan 15. 22 (1):[QxMD MEDLINE Link].
Levandoski KA, Girardi NA, Loss MJ. Eruptive sebaceous hyperplasia as a side effect of oral tacrolimus in a renal transplant recipient. Dermatol Online J. 2017 May 15. 23 (5):[QxMD MEDLINE Link].
Boschnakow A, May T, Assaf C, Tebbe B, Zouboulis ChC. Ciclosporin A-induced sebaceous gland hyperplasia. Br J Dermatol. 2003 Jul. 149(1):198-200. [QxMD MEDLINE Link].
Engel F, Ellero B, Woehl-Jaegle ML, Cribier B. [Diffuse sebaceous hyperplasia of the face induced by cyclosporine]. Ann Dermatol Venereol. 2005 Apr. 132(4):342-5. [QxMD MEDLINE Link].
McDonald SK, Goh MS, Chong AH. Successful treatment of cyclosporine-induced sebaceous hyperplasia with oral isotretinoin in two renal transplant recipients. Australas J Dermatol. 2011 Aug. 52(3):227-30. [QxMD MEDLINE Link].
Kanada KN, Merin MR, Munden A, Friedlander SF. A prospective study of cutaneous findings in newborns in the United States: correlation with race, ethnicity, and gestational status using updated classification and nomenclature. J Pediatr. 2012 Aug. 161(2):240-5. [QxMD MEDLINE Link].
Moosavi Z, Hosseini T. One-year survey of cutaneous lesions in 1000 consecutive Iranian newborns. Pediatr Dermatol. 2006 Jan-Feb. 23(1):61-3. [QxMD MEDLINE Link].
Johnson PJ, Heckler F. Muir-Torre syndrome. Ann Plast Surg. 1998 Jun. 40(6):676-7. [QxMD MEDLINE Link].
Finan MC, Apgar JT. Juxta-clavicular beaded lines: a subepidermal proliferation of sebaceous gland elements. J Cutan Pathol. 1991 Dec. 18(6):464-8. [QxMD MEDLINE Link].
Argenziano G, Zalaudek I, Corona R, et al. Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol. 2004 Dec. 140(12):1485-9. [QxMD MEDLINE Link].
Bryden AM, Dawe RS, Fleming C. Dermatoscopic features of benign sebaceous proliferation. Clin Exp Dermatol. 2004 Nov. 29(6):676-7. [QxMD MEDLINE Link].
Zaballos P, Ara M, Puig S, Malvehy J. Dermoscopy of sebaceous hyperplasia. Arch Dermatol. 2005 Jun. 141(6):808. [QxMD MEDLINE Link].
Oztas P, Polat M, Oztas M, Alli N, Ustun H. Bonbon toffee sign: a new dermatoscopic feature for sebaceous hyperplasia. J Eur Acad Dermatol Venereol. 2008 Nov. 22(10):1200-2. [QxMD MEDLINE Link].
Alexiades-Armenakas M. Laser-mediated photodynamic therapy. Clin Dermatol. 2006 Jan-Feb. 24(1):16-25. [QxMD MEDLINE Link].
Horio T, Horio O, Miyauchi-Hashimoto H, Ohnuki M, Isei T. Photodynamic therapy of sebaceous hyperplasia with topical 5-aminolaevulinic acid and slide projector. Br J Dermatol. 2003 Jun. 148(6):1274-6. [QxMD MEDLINE Link].
Bader RS, Scarborough DA. Surgical pearl: intralesional electrodesiccation of sebaceous hyperplasia. J Am Acad Dermatol. 2000 Jan. 42(1 Pt 1):127-8. [QxMD MEDLINE Link].
Rosian R, Goslen JB, Brodell RT. The treatment of benign sebaceous hyperplasia with the topical application of bichloracetic acid. J Dermatol Surg Oncol. 1991 Nov. 17(11):876-9. [QxMD MEDLINE Link].
Aghassi D, Gonzalez E, Anderson RR, Rajadhyaksha M, Gonzalez S. Elucidating the pulsed-dye laser treatment of sebaceous hyperplasia in vivo with real-time confocal scanning laser microscopy. J Am Acad Dermatol. 2000 Jul. 43(1 Pt 1):49-53. [QxMD MEDLINE Link].
Walther T, Hohenleutner U, Landthaler M. [Sebaceous gland hyperplasia as a side effect of cyclosporin A. Treatment with the CO2 laser]. Dtsch Med Wochenschr. 1998 Jun 19. 123(25-26):798-800. [QxMD MEDLINE Link].
Liu YS, Cheng YP, Liu CI, Yang CY, Yang CY. Presenile diffuse familial sebaceous hyperplasia successfully treated with low-dose isotretinoin: A report of two cases and review of the published work. J Dermatol. 2016 Oct. 43 (10):1205-1208. [QxMD MEDLINE Link].
Yu C, Shahsavari M, Stevens G, Liskanich R, Horowitz D. Isotretinoin as monotherapy for sebaceous hyperplasia. J Drugs Dermatol. 2010 Jun. 9(6):699-701. [QxMD MEDLINE Link].

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.

of 6

Author

David T Robles, MD, PhD, FAAD Director, Dermatology Division, Chaparral Medical Group

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.