Overview

Sebaceous hyperplasia is a common, benign skin condition characterized by small, yellowish or flesh-colored bumps that form when the sebaceous (oil) glands in the skin become enlarged. These bumps usually appear on areas of the skin where sebaceous glands are most concentrated, such as the face—particularly the forehead, cheeks, and nose. While sebaceous hyperplasia is harmless and non-cancerous, it can sometimes be mistaken for other skin growths, such as basal cell carcinoma, making proper diagnosis important. The condition is more frequently observed in middle-aged and older adults.

Causes

The primary cause of sebaceous hyperplasia is the overgrowth of sebaceous glands, but several factors contribute to its development:

• Natural aging process: The condition is more common in individuals over the age of 40 as sebaceous glands become enlarged with age.
• Genetic predisposition: A family history of sebaceous hyperplasia increases the likelihood of developing the condition.
• Hormonal changes: Hormonal fluctuations, especially a decrease in androgens, may lead to gland enlargement.
• Chronic sun exposure: Prolonged UV exposure may damage skin and contribute to sebaceous gland overgrowth.
• Use of certain medications: Drugs like cyclosporine, used after organ transplantation, have been linked to sebaceous hyperplasia.
• Oily skin: Individuals with naturally oily skin may be more prone to sebaceous gland enlargement.

Symptoms

Sebaceous hyperplasia presents with specific skin-related features, which help distinguish it from other skin conditions:

• Small bumps on the skin: Usually 2-5 millimeters in diameter, soft, and flesh-colored or yellowish.
• Central depression: Many lesions have a small central indentation or dimple.
• Location: Most commonly found on the face, especially forehead, cheeks, and nose, but can appear elsewhere on oily skin areas.
• No pain or itching: Typically painless and asymptomatic, though some individuals may experience mild irritation.
• Slow growth: Lesions develop slowly over time and do not regress without treatment.

Diagnosis

Diagnosis of sebaceous hyperplasia is primarily clinical, but additional tests may be performed if there's uncertainty:

• Physical examination: Dermatologists diagnose based on the characteristic appearance of the bumps.
• Dermatoscopy: A handheld device magnifies the lesion, helping differentiate sebaceous hyperplasia from skin cancers.
• Skin biopsy: In rare cases where diagnosis is unclear, a biopsy may be performed to rule out malignancy, especially basal cell carcinoma.

Treatment

Although sebaceous hyperplasia is harmless and often does not require treatment, cosmetic concerns or irritation may prompt intervention. Treatment options include:

• Electrosurgery: A small electrical current removes the lesions by burning the excess tissue.
• Cryotherapy: Liquid nitrogen is applied to freeze and destroy the bump.
• Laser therapy: Lasers such as CO2 or pulsed-dye lasers can vaporize the overgrown glands with precision.
• Topical treatments: Medications like retinoids (tretinoin) may reduce the size or prevent formation of new lesions.
• Photodynamic therapy (PDT): A combination of light and photosensitizing agents used to treat multiple lesions at once.
• Surgical excision: Rarely used but effective for single large lesions.
• Oral medications: In resistant or widespread cases, systemic retinoids (like isotretinoin) may be considered under medical supervision.

Prognosis

The prognosis for sebaceous hyperplasia is excellent as it is a benign, non-cancerous condition:

• Non-threatening: The condition poses no risk of cancer or serious complications.
• Recurrence possible: Lesions can recur after treatment, especially if underlying factors like sun exposure are not addressed.
• Cosmetic impact: Some people may feel self-conscious, but treatment can effectively improve appearance.
• Long-term management: Regular skincare, sun protection, and in some cases, retinoids can help prevent new lesions.

Overall, with appropriate care and treatment, individuals with sebaceous hyperplasia can manage the condition successfully with minimal impact on quality of life.