Sebaceous hyperplasia (SH) is a prevalent, benign skin condition characterized by the enlargement of the sebaceous glands, the small oil-producing glands in the skin. This overgrowth leads to the formation of small bumps, most commonly appearing on the face, particularly the forehead and cheeks. The condition is entirely non-cancerous and poses no threat to health, though it is often a cosmetic concern. SH is a structural change in the gland itself, not a form of acne.
Understanding the Root Causes
The underlying mechanism for sebaceous hyperplasia involves a disruption in the normal cell cycle of the sebaceous glands. These glands are composed of sebocytes, which naturally produce the oily substance called sebum. The overgrowth occurs because the sebocytes multiply too quickly and do not break down at the normal rate, leading to cellular crowding and the enlargement of the entire gland structure.
The most significant contributing factor is the aging process, which is why the condition is most common in middle-aged and older adults. As the body ages, hormone levels change, specifically declining circulating androgen levels. This decrease in androgens paradoxically slows the natural turnover and death of sebocytes, resulting in their accumulation and subsequent enlargement of the glands.
Genetic predisposition plays a part; individuals with a family history of the condition may be more likely to develop it. Chronic exposure to ultraviolet (UV) light from the sun is considered a secondary risk factor, contributing to the development of lesions, especially on sun-exposed skin. People with naturally oily skin types tend to be more prone to developing sebaceous hyperplasia due to the existing activity of their sebaceous glands.
Identifying and Confirming the Diagnosis
Sebaceous hyperplasia lesions have a distinct physical appearance that helps in their identification. They present as small, dome-shaped papules, usually measuring between 2 to 5 millimeters in diameter. The bumps are often described as having a yellowish or flesh-colored hue and a slightly shiny texture.
The presence of a central depression, known as umbilication, is characteristic, marking where the enlarged duct of the sebaceous gland opens to the surface. A dermatologist can usually confirm the diagnosis through a visual inspection, often aided by a dermatoscope, which magnifies the lesion. Dermoscopy reveals specific patterns, such as a cluster of yellowish lobules, indicative of the benign growth.
It is necessary to differentiate sebaceous hyperplasia from basal cell carcinoma (BCC), a common type of skin cancer that can resemble it. While SH lesions are typically multiple and yellow, BCC lesions are often solitary, may appear pink or red, and can exhibit a pearly border. If a physician has any doubt, a skin biopsy may be performed to microscopically examine the tissue and definitively rule out malignancy.
Removal and Management Strategies
Treatment for sebaceous hyperplasia is generally pursued for cosmetic reasons, as the lesions are harmless. Several effective physical removal methods exist, all of which aim to destroy the enlarged gland structure.
Electrocautery, or electrodessication, is a common technique that uses a fine needle to deliver an electrical current, burning the lesion so it scabs and heals. Laser therapy provides another precise option; CO2 lasers are effective at ablating the enlarged tissue, while other lasers, like the 1450-nm diode laser, target the sebaceous glands to shrink them. Cryotherapy involves freezing the lesion with liquid nitrogen, causing the sebaceous gland to shrink and slough off. All physical removal methods carry a small risk of scarring or temporary changes in skin color, such as hypopigmentation.
Topical treatments are primarily used for management rather than permanent removal. Prescription-strength topical retinoids, such as Tretinoin, can help reduce the size and appearance of the lesions over time by regulating sebocyte activity. For widespread or highly recurrent cases, oral retinoids may be prescribed to significantly reduce sebum production and gland size, though this requires careful medical supervision. Because the underlying hormonal and genetic factors persist, sebaceous hyperplasia lesions have a tendency to recur months or years after any treatment is performed.