Sebaceous hyperplasia presents as a doughnut-type looking lesion on the skin. They are typically small, flesh-colored and round, with a ‘hole’ in the middle. The good news is sebaceous hyperplasia is completely benign and does not require treatment; however, the lesions can be cosmetically undesirable and tend to recur unless it is entirely destroyed or excised, so risk of permanent scarring is a concern. Also, a biopsy may be necessary to rule out basal cell carcinoma. Treatments for sebaceous hyperplasia vary, depending on the symptoms: Tretinoin cream or gel applied topically, as well as oral isotretinoin can be prescribed only if the nodules are severe or cover a considerably large area. For women, prescription androgen antagonists (such as spironolactone) can be used. Also, photodynamic therapy, photoradiation and various types of laser treatments are available.
Sebaceous hyperplasia is seen in about 1% of the population, and is common in those around middle age and the elderly. It is also seen in approximately 10-16% of those who are on a semipermanent use of ‘cyclosporin A’ for organ transplantations.
What causes sebaceous hyperplasia?
During the time before birth, our sebaceous glands are initially large and are likely responsible for the production of vernix caseosa, which is the white coating covering the body of a newborn. Shortly after birth, the sebaceous glands regress and remain small throughout infancy and childhood. At puberty, sebaceous glands enlarge and become increasingly active due to an increased production of androgens (male hormones), and they reach their maximum by the third decade of life. As we get older our androgen levels decrease and the sebocyte turnover (an epithelial cell that produces sebum) begins to slow down.
This decrease in cell turnover results in crowding of primitive sebocytes within the sebaceous gland, causing a benign tumor-like nodule or enlargement of the sebaceous gland, commonly known as sebaceous hyperplasia. This is particularly apparent in the areas where sebaceous glands are concentrated, such as the face. Although the affected glands are often inflated up to 10 times their normal size, they secrete very little sebum. Also, the affected sebaceous glands contain small, un-evolved sebocytes with large nuclei and very little lipid; whereas, normal sebocytes are engorged with lipids.
TCA chemical peels may be used to minimize the appearance; however, new nodules will keep forming. As always, it is strongly recommended that the clinician consult a dermatologist for diagnosis and appropriate treatment before applying any kind of creams and/or gels, or before performing ANY TYPE of treatment, in order to avoid any further skin complications.