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Sebaceous Hyperplasia – Symptoms, Causes, and Treatment.

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.

Pathophysiology

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

Risk Factors of sebaceous hyperplasia

How can I tell if I have sebaceous hyperplasia?

Complications

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.

Physical Examination

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.

Skin Biopsy

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

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.

Facial peels

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.

Laser therapy

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.

Cryotherapy

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

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

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.

Surgery

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.

Antiandrogen medications

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.

Home remedies

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:

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