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INTRODUCTION

Sebaceous hyperplasia appears as 1-to-3-mm yellow umbilicated papules with overlying telangiectasias on the face of middle-aged individuals (Fig. 15.1). They represent a benign proliferation of sebaceous glands. The lesions are sometimes mistaken for basal cell carcinoma.

Figure 15.1

Large sebaceous hyperplasia on the forehead

EPIDEMIOLOGY

Incidence: very common

Age: most commonly middle age and elderly but can appear in young individuals as well

Race: more common in Caucasians

Sex: equal

Precipitating factors: organ transplantation is a rare precipitant

PATHOGENESIS

Unknown.

PATHOLOGY

Increased numbers of large, mature sebaceous lobules are clustered around a central duct in the upper dermis. The lobules lie closer than normal to the epidermis.

PHYSICAL LESIONS

There are single or multiple 1-to-3-mm yellow umbilicated papules with overlying telangiectasias that appear on the face. The forehead, cheeks, and nose are the most common locations. It can rarely present on the areola.

DIFFERENTIAL DIAGNOSIS

Most commonly mistaken for basal cell carcinoma.

LABORATORY EXAMINATION

None is indicated. Biopsy if considering basal cell carcinoma.

COURSE

Benign, but do not regress or resolve without therapy.

KEY CONSULTATIVE QUESTIONS

Any history of the lesion bleeding.

MANAGEMENT

There is no medical indication to treat sebaceous hyperplasia. Still, some individuals are significantly bothered by its appearance and request removal, particularly in the circumstance of multiple lesions. Treatments include oral, destructive, laser, and photodynamic therapies. Each has its side effects and risk of recurrence.

TREATMENTS

All patients should be informed before any treatment modality that improvement is variable and in the future new lesions may arise requiring follow-up treatments.

Destructive Modalities

  • “Light” cryotherapy and electrosurgery are quick, inexpensive means of treating sebaceous hyperplasia.

Laser Therapy

  • The 1,450-nm diode laser has been studied in 10 patients for the treatment of sebaceous hyperplasia (Figs. 15.2 and 15.3).

Figure 15.2

(A) Patient with sebaceous hyperplasia on the right temple and forehead. (B) Improvement 1 month after treatment with 1,450-nm diode laser (Smoothbeam, Candela Corp., Wayland, MA) utilizing a 6-mm spot with a fluence of 14 J/cm2 and a pulse duration of 35 ms

Figure 15.3

(A) Sebaceous hyperplasia—before. (B) Improvement one month after treatment with 1450 nm diode laser 14.5 J/cm2, 35 ms cooling, ...

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