Core Dermatology Diagnoses / CategoriesNeoplastic Benign and Malignant

Sebaceous hyperplasia

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Publish date: Posted on
Last updated: August 18, 2022

Keywords #

sebaceous hyperplasia
sebaceous glands

Diagnosis #

Sebaceous hyperplasia (SH) is a relatively common and benign condition that represents enlargement of the sebaceous glands.[1] Lesions typically appear on the central face and forehead, and occasionally on the upper trunk or anogenital skin.[1,2] SH usually affects adults over the age of forty or immunocompromised individuals.[2] Due to the benign nature of these lesions, treatment is primarily cosmetic in nature, though some cases can be extensive and disfiguring.[1,2]

Key Concepts #
  • SH is a relatively common and benign condition.
  • It occurs most often in older adults or the immunosuppressed.
  • It is characterized by single to multiple yellowish papules with a central dell and crown vessels that do not cross through the center of the papule.
  • Lesions are most commonly located on the central face, forehead, or upper trunk.
  • SH can mimic basal cell carcinoma (BCC).
  • Treatment is primarily cosmetic; treatment options include shave removal, cryotherapy, electrodessication, laser, or topical retinoids.
Epidemiology #

SH occurs in approximately 1-26% of the adult population. The prevalence is increased in immunosuppressed individuals by 10-30-fold and is commonly found in those treated with cyclosporine. SH has also been reported in infants as a primarily physiologic phenomenon, as well as in young adults with a family history of SH.[2]

Clinical Features #
  • SH is characterized by single to multiple yellowish papules with a central dell corresponding to the gland’s ostium and crown vessels.
  • Dermoscopic findings of “crown vessels” that do not cross the middle of the papule assist in making the clinical diagnosis of SH.
  • Lesions are usually located on the central face, forehead, or upper trunk.[1]
  • Juxta-clavicular beaded lines represent a rare form of SH, in which a linear arrangement of typical-appearing SH papules occurs on the neck or clavicle.[1,2] This variant usually occurs in the second to fifth decades of life and is more common among African Americans.[2]
Differential Diagnoses #
Diagnostic Workup #

The diagnosis of SH can be made clinically based on the distribution and characteristics of the lesions. Dermoscopic evaluation can aid in making the diagnosis.

Biopsy is typically unnecessary but is sometimes indicated to exclude BCC. The pathology demonstrates enlarged sebaceous lobules situated around a central infundibulum. A thin layer of seboblasts can be seen at the periphery of the lobules.[1,2]

The yellowish color and central dell help to differentiate SH from BCC. Additionally, dermoscopic findings that demonstrate “crown vessels” as opposed to the arborizing vessels of BCC assist in making the diagnosis.[1]

Treatment #

If removal is desired, electrodessication, cryotherapy, laser ablation, and shave removal are options for therapy. Topical retinoids may also be helpful. Short courses of isotretinoin can be utilized for patients with more extensive lesions.[1,2]

Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/?diagnosis=sebaceous_hyperplasia
References #
  1. McCalmont, TH & Pincus, LB. Adnexal Neoplasms. In: Bolognia JL, Schaffer JV, & Cerroni L, eds. Dermatology. 4th edition. China: Elsevier; 2018: 1930-1953.
  2. Eisen DB, Michael DJ. Sebaceous lesions and their associated syndromes: part I. J Am Acad Dermatol. 2009 Oct;61(4):549-60; quiz 561-2. doi:10.1016/j.jaad.2009.04.058. Review. PubMed PMID: 19751879.
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