Published on 16/03/2015 by admin
Filed under Dermatology
Last modified 16/03/2015
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Agustin Martin-Clavijo and John Berth-Jones
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Sebaceous hyperplasia is a common benign condition. Incidence increases with age, but it may occur at any time and even at birth. It presents as single or multiple soft yellow papules, often with central umbilication, typically measuring 1–4 mm, mainly on the face (commonly the nose, cheeks, and forehead). Less commonly lesions are seen in other areas such as the chest, areola, mouth, and genitalia. Its frequency is increased in immunocompromised patients, especially after transplantation in patients on cyclosporine and corticosteroids.
This is a benign condition with no potential for malignant transformation. Lesions are asymptomatic and therefore need treatment only for cosmetic reasons. The differential diagnosis includes rhinophyma, nevus sebaceous, basal cell carcinoma, dermal nevus, plane warts, lupus miliaris disseminatus faciei, and syringoma.
We normally use cautery (electrodesiccation) or cryotherapy first-line. It can be helpful to treat some test lesions to assess patient satisfaction before treating the rest. Other treatments include surgical excision, photodynamic therapy, laser, isotretinoin, and chemical peels. It is important to stress to the patient the risk of scarring with many of these techniques.
No specific investigations are usually needed, as the diagnosis is clinical.
If the diagnosis is uncertain, histology will show enlargement of individual glands with increased numbers of fully mature lobules with no atypia or dysplasia.
Perez-Espana L, Prats I, Sanz A, Mayor M. Nefrologia 2003; 23: 179–80.
The authors looked at 163 renal transplant patients, of whom 25.9% had sebaceous hyperplasia. This was greatest in patients on cyclosporine. However, other immunosuppressants (azathioprine, mycophenolate mofetil, and tacrolimus) showed no significant increase in the incidence of sebaceous hyperplasia.
Bader RS, Scarborough DA. J Am Acad Dermatol 2000; 42: 127–8.
The authors describe the technique for intralesional electrodesiccation. They used it on more than 30 patients with no recurrences after 7 months.
American Academy of Dermatology Committee on Guidelines of Care. J Am Acad Dermatol 1994; 31: 648–53.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Conservative management/cosmetic camouflage
Electrodesiccation/cautery
Cryotherapy
