What is a sebaceous gland hyperplasia?
Physiologically we have a sebaceous gland associated with each hair follicle of hair and hair. Hyperplasia corresponds to a benign enlargement of the sebaceous lobe around the hair follicle, of unknown cause associated with normal skin aging.
What do they look like?
Hyperplasias of the sebaceous glands manifest as cupuliform papules (“pimples”) with a central depression, yellowish or normal skin in color, with a size of 1-4mm. They are usually located in areas rich in sebum, such as the forehead and cheeks. Even if pressed, they emit practically no material to the outside.
Are they dangerous?
No. It is a benign enlargement of the sebaceous lobes of the gland, and they do not have any malignant potential. It is an exclusively aesthetic alteration, so treatment is not necessary if it is not desired.
It should be noted, however, that a higher incidence of non-melanoma skin cancer has been documented in people who have sebaceous hyperplasias.
Why do they appear?
Sebaceous hyperplasias are part of the normal process of skin aging , although they can be associated with chronic immunosuppression in organ transplant patients, especially if they are treated with cyclosporine.
Are sebaceous gland hyperplasias very common?
Yes. It is considered that they can appear in up to 1% of the normal population and up to 16% in people treated with cyclosporine. They usually appear around the 5th – 6th decade of life.
How are they diagnosed?
The diagnosis is usually clinical with observation with dermoscopy, which presents characteristic findings. Rarely, a biopsy can be performed to differentiate it from other skin lesions.
How are sebaceous hyperplasias treated?
If they are to be removed, it is necessary to destroy the entire glandular unit otherwise they will recur. There are different methods of elimination, such as photodynamic therapy, electrocoagulation or cryotherapy. Although these methods are valid, the first has a very high cost, the second has a no less risk of leaving a scar and the third usually incurs in recurrences of the lesion.
In the author’s opinion, the therapeutic method that offers the best profile is CO2 laser removal. This device allows the lesion to be destroyed precisely, preserving the rest of the skin healthy (thus reducing the risk of scarring) and without entailing a high cost due to the benefit obtained. Recovery is usually excellent, with minimal crusts that come off in a few days.
What does laser treatment of sebaceous hyperplasia consist of?
Because sebaceous hyperplasias are usually not bulky or deep, this technique can usually be performed with or even without a numbing cream . Otherwise, it can be done under local anesthesia.
Subsequently, the lesions are fulgurated with the CO2 laser, which allows it to be carried out with precision, throwing only the energy on the lesions without damaging the surrounding skin.
After the procedure, a pink erosion and a thin crust that comes off spontaneously within a few days is formed. It should only be borne in mind that strict SPF 50 sun protection must be used after removal.
ACKNOWLEDGEMENTS
To Dr. Leo Barco, for his excellent clinical photos. Visit his online atlas.
REFERENCES
· Bisaccia E et al. Treatment of extensive sebaceous hyperplasia. The Dermatologist 2011. 19(4): 40-42.
