What is sebaceous hyperplasia?
Sebaceous hyperplasia is the term used for enlarged sebaceous glands seen on the forehead or cheeks of the middle-aged and older people. Sebaceous hyperplasia appears as small yellow bumps up to 3 mm in diameter. Close inspection reveals a central hair follicle surrounded by yellowish lobules. There are often prominent blood vessels, best seen using dermoscopy.
Sebaceous hyperplasia is a form of benign hair follicle tumour. The lesions are sometimes confused with basal cell carcinoma. It may be more prevalent in immunosuppressed patients: for example, in a patient following organ transplantation.
Sebaceous glands are found throughout the skin except on the palms and soles. They exist as a component of the pilosebaceous unit or, less frequently, open directly to the epithelial surface in areas of modified skin, including the lips and buccal mucosa (as Fordyce spots), glans penis or clitoris (as Tyson glands), areolae (as Montgomery glands), and eyelids (as meibomian glands). The largest and greatest numbers of sebaceous glands are found on the face, chest, back, and the upper outer arms.
These holocrine glands are composed of acini attached to a common excretory duct. The life cycle of a sebocyte, the cells that form the sebaceous gland, begins at the periphery of the gland in the highly mitotic basal cell layer. As sebocytes differentiate and mature, they accumulate increasing amounts of lipid and migrate toward the central excretory duct. The mature sebocytes complete their life cycle at the central duct and disintegrate, releasing their lipid contents as sebum. The turnover time from sebocyte production to disintegration is approximately 1 month.
Sebaceous glands are highly androgen sensitive, and, although the number of sebaceous glands remains approximately the same throughout life, their activity and size vary according to age and circulating hormone levels. Together, sebaceous and sweat glands account for the vast majority of androgen metabolism in the skin.
Sebocytes contain androgen-metabolizing enzymes, including 5-alpha-reductase type I, 3-beta-hydroxysteroid dehydrogenase, and 17-beta-hydroxysteroid dehydrogenase type II. These enzymes metabolize relatively weak circulating androgens, such as dehydroepiandrosterone-sulfate, into the more potent androgens, such as dihydrotestosterone. These, in turn, bind to receptors within the sebocytes, causing an increase in the size and metabolic rate of the sebaceous gland. Studies have shown that the activity of 5-alpha-reductase is higher in the scalp and facial skin than in other areas, so that testosterone and dihydrotestosterone stimulate more sebaceous gland proliferation in these areas. Estrogens, on the other hand, have been found to decrease sebaceous gland secretion.
In the perinatal period, the sebaceous glands are initially large and are likely responsible for the production of vernix caseosa often seen in newborns. The activity and size of the sebaceous glands regress shortly after birth, due to withdrawal of maternal hormones, and remain small throughout infancy and childhood. At puberty, sebaceous glands enlarge and become increasingly active due to increased production of androgens, reaching their maximum by the third decade of life. As androgen levels decrease with advancing age, the sebocyte turnover begins to slow down.
This decrease in cellular turnover results in crowding of primitive sebocytes within the gland, resulting in enlargement. In contrast to normal sebocytes that are engorged with lipid, the hyperplastic sebaceous glands contain small undifferentiated sebocytes with large nuclei and scant cytoplasmic lipid.
Causes of sebaceous hyperplasia
- There are several factors that contribute to sebaceous hyperplasia. The biggest is a decrease in androgen hormones. Androgen hormones play a big role in the inner workings of our sebaceous glands.
- Androgens (specifically testosterone) stimulate the sebaceous glands to create more oil. When there is an increase in androgens, there is also an increase in sebaceous gland activity.
- During puberty, there is a huge increase in androgens. That’s why your skin is typically much more oily during the teen years than it is at other times in your life. It also explains why acne spikes during puberty; there is a similar spike in androgens.
- As we age, androgen hormones decrease. This slows down the sebaceous gland activity. And it’s not just oil production. The natural cell turnover rate within the sebaceous glands slows down as well. The cells back up within the gland, causing that overabundance and enlargement of the gland.
- There also seems to be a genetic link. If someone in your family has sebaceous hyperplasia, you’re more prone to developing it too, because it is hereditary (but not contagious).
Risk Factors of sebaceous hyperplasia
- Sebaceous hyperplasia is more common as you get older. Typically, it doesn’t appear until middle age or older.
- Some people get sebaceous hyperplasia at a much earlier age if there is a strong family history of it, though this is rarer.
- Sebaceous hyperplasia affects both men and women about equally. It’s seen most often in people with light or fair complexions.
- the condition is also much more common in those taking cyclosporin long-term, such as people who have had a transplant.
- Newborns can develop this condition too (often alongside baby acne), because of hormones passed from mother to baby. The blemishes most often appear on the nose, cheeks, upper lip, and forehead.
- There’s no reason to treat this condition in newborns. The bumps recede and disappear on their own, within a few months after delivery, as maternal hormones dissipate.
How can I tell if I have sebaceous hyperplasia?
- The main symptom of sebaceous hyperplasia is a small, shiny bump under the skin. A bump can appear on its own or in a small cluster. These are usually painless. Sometimes the bump can be difficult to distinguish between acne.
- The easiest way to tell them apart is that a whitehead or blackhead will usually have a lifted center, but bumps that are sebaceous hyperplasia are indented.
- The lesions are small, cream-colored or yellowish, umbilicated papules 2-6 mm in diameter. They are tiny yellow donuts in the skin and this makes sense since they are prominent sebaceous glands.
- It most often develops on the face, especially the forehead, cheeks, and nose.
- Sebaceous hyperplasia can happen anywhere there are many sebaceous glands, including the back and chest, shoulders, areola, penis, scrotum, and vulva. However, it is much rarer in these areas.
Irritation or bleeding may occur if lesions are in an area prone to trauma (eg, friction by a comb or brush).
Diagnosis of sebaceous hyperplasia
Professionals only analyze the skin; to get the correct diagnosis, the client must see a medical provider who uses the following steps to confirm findings, discover the cause, and choose the best treatment option for the patient.
Sebaceous hyperplasia is often found incidentally upon examination. The classic appearance of facial sebaceous hyperplasia on physical examination reveals whitish-yellow or skin-colored papules that are soft and vary in size from 2-9 mm. These papules have a central umbilication from which a very small globule of sebum can sometimes be expressed. Some papules may be associated with characteristics similar to basal cell carcinoma, such as telangiectasia.
Depending on the variant, sebaceous hyperplasia may be found singularly, grouped (as in the nevoid and linear form), diffuse, or extensive. Juxtaclavicular beaded lines are an additional variant characterized by closely placed papules arranged in parallel rows within the skin of the neck and overlying the clavicle.
Medical History Assessment
The dermatologist will assess and find a previous history of lesions and bumps. It helps to find the causes of sebaceous hyperplasia.
Skin Analysis Wood Lamp
Wood lamp examination is a diagnostic test in which the skin or hair is examined while exposed to the black light emitted by Wood lamp. Blacklight is invisible to the naked eye because it is in the ultraviolet spectrum, with a wavelength just shorter than the colour violet. The lamp glows violet in a dark environment because it also emits some light in the violet part of the electromagnetic spectrum.
A skin biopsy is a procedure that removes a small sample of skin for testing. The skin sample is looked at under a microscope to check for skin cancer, skin infections, or skin disorders such as psoriasis. A biopsy may be necessary to rule out basal cell carcinoma. However, papules of sebaceous hyperplasia are typically multiple and yellowish and are observable as small lobules with the aid of magnification dermoscopy.
Dermoscopy Lesion Analysis
Dermoscopy may be useful as a noninvasive tool to aid in the clinical diagnosis and in distinguishing between nodular basal cell carcinoma and sebaceous hyperplasia, reducing unnecessary surgery.
Treatment for sebaceous hyperplasia
Sebaceous hyperplasia is harmless in most cases. However, if the bumps are unsightly or embarrassing, a person may choose to have them removed. Various methods are available, but a person may require multiple sessions for complete removal.
Possible treatments include:
Retinol is a form of vitamin A that may help with a range of skin-related issues. Prescription retinoids are often recommended for people with sebaceous hyperplasia. However, these may require regular application to work as intended.
Studies show that the regular application of retinoids can be an effective treatment for sebaceous hyperplasia. However, the bumps may also return if a person stops using the treatment.
A facial peel may contain chemicals such as salicylic acid. Chemical facial peels can cause irritation, redness, and sensitivity. This can aggravate sebaceous hyperplasia if a person does not receive proper aftercare.
A dermatologist may recommend removing lesions using CO2 laser therapy. This can reduce the thickness of lesions and result in smoother skin without notable scarring.
A doctor can remove sebaceous hyperplasia bumps in a process called cryotherapy. The doctor will freeze the bumps, causing them to dry up and drop away. However, cryotherapy can potentially cause changes in skin color in the affected area.
Electrocautery involves using a charge of electricity to burn the bump. The skin will then scab over and fall away, leaving behind a smooth area. Electrocautery may cause skin pigment changes in the affected area and can potentially leave indented scars if not performed properly.
Photodynamic therapy involves applying a drug to the affected cells that makes them sensitive to light. Controlled exposure to intense light can then kill the cells. The skin may become extremely sensitive after treatment, leading to redness, irritation, and peeling.
If sebaceous hyperplasia is severe or persistent, a doctor may consider surgically removing the bumps. This will prevent them from returning, but it can cause scarring and is usually considered a last resort.
There may be a link between sebaceous hyperplasia and increased testosterone. Some doctors may recommend antiandrogen medications for women with severe symptoms who do not respond well to other treatment methods.
- Some home remedies can also diminish bumps caused by sebaceous hyperplasia. However, most home remedies are based on anecdotal evidence and not backed up by human clinical trials.
- Over-the-counter medications, creams, and face washes that contain retinol may help clear clogged sebaceous glands.
- Some people find that regularly washing with a cleanser containing salicylic acid can help dry oily skin and prevent clogged glands.
- Warm compresses may also draw out any trapped sebum. While a warm compress may not get rid of bumps altogether, they may help reduce swelling and inflammation.
Prevention of sebaceous hyperplasia
Because there is not a definitive cause for sebaceous hyperplasia, a prevention plan that will be 100 percent effective cannot be determined. The best way to avoid developing this condition is by maintaining a healthy diet, lifestyle, and skin care routine. Clients should be sure to include the following:
- Daily cleansing, morning and night.
- Regular exfoliation, including professional facial peels.
- Daily intake of vitamins and minerals.
- Avoidance of foods that interfere with hormone or pH levels. Limited consumption of red meats, cheese, and butter. Organic milk, organic fresh foods rich in vitamin C, beta-carotene, the omegas, and probiotics should be prioritized.
- Drinking adequate amounts of water. The National Academy of Medicine (NAM) updated recommended guidelines to 3.7 liters for an adult male and 2.7 liters for a female, but these numbers include the water found in foods eaten. People should drink when thirsty and, when drinking caffeinated beverages, make a concentrated effort to drink additional amounts of water.
- Areas affected by sebaceous hyperplasia should not be irritated.
- Regular exercise promoting proper circulation to skin, keeping it vibrant and healthy.
- Attention should be paid to suspicious lesions; if something does not look right, clients should see a medical professional.