Medical Care
Sebaceous hyperplasia is completely benign and does not require treatment; however, lesions can be cosmetically unfavorable and sometimes bothersome when irritated. Treatments are mostly mechanical. Lesions tend to recur unless the entire unit is destroyed or excised. Risk of permanent scarring must be considered when treating benign lesions.
A biopsy may be necessary if concern exists that the lesion is a basal cell carcinoma.
Therapeutic options include photodynamic therapy (with combined use of 5-aminolevulinic acid and visible light), [32, 33] cryotherapy (liquid nitrogen), cauterization or electrodesiccation, [34] topical chemical treatments (eg, with bichloracetic acid or trichloroacetic acid), [35] laser treatment (eg, with argon, carbon dioxide, or pulsed-dye laser), [36, 37] shave excision, and excision. Complications of these nonspecific destructive therapies include atrophic scarring or transient dyspigmentation.
Oral isotretinoin has proven effective in clearing some lesions after 2-6 weeks of treatment, but lesions often recur upon discontinuation of therapy. However, several cases of sustained improvement or clearance after cessation of therapy were reported in 2016, following cumulative doses ranging from 40-60 mg/kg. [38] Daily treatment doses range from 0.5 mg/kg/day to 1 mg/kg/day. [38] Maintenance doses of oral isotretinoin ranging from 10-40 mg every other day or 0.05% isotretinoin gel (not marketed in the United States) is rarely indicated as a suppressive treatment for widespread disfiguring sebaceous hyperplasia, which recurs despite therapy. [17, 39] Oral isotretinoin should be prescribed by a physician who is experienced in oral retinoid therapy and only for patients without contraindications and fully compliant with all restrictions on this medication. Other topical retinoids are considered less effective in treating this condition.
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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.
