Treatment of Sebaceous Hyperplasia by Laser Modalities: A Review of the Literature and Presentation of Our Experience With Erbium-doped Yttrium Aluminium Garnet (Er:YAG).

INTRODUCTION: Sebaceous hyperplasia (SH) is a common skin presentation in adults. Due to their unwanted yellow papular appearance, patients may desire their removal. Although several treatment modalities have been reported, the full range and efficacy of options are unclear. OBJECTIVE: To determine the efficacy of laser modalities in the treatment of SH. The authors will also specifically assess the efficacy, recurrence rate and side effect profile of SH treatment with Er:YAG wavelength using a variable long pulsed (VLP) Er:YAG laser (SP Dynamis Fotona laser, Ljubljana, Slovenia) Methods & Materials: A comprehensive literature search was performed through PubMed, EMBASE, and Web of Science, using the search terms [(sebaceous hyperplasia)] and [(laser[s], Er:Yag, Er:Glass, Fraxel, CO2, PDL, Pulse dye laser, Diode, Xe-Cl, Excimer, Argon, KTP, Ruby, Alexandrite or Nd:YAG)]. The search yielded a total of 119 results and 8 were identified as relevant to this reviewResults: Pulse dye laser (PDL) provides a wide range of treatment results from complete reduction to flattening of the SH without significant adverse events; recurrence rates were unreported. Short PDL showed faster treatment response than long PDL. CO2 laser can produce considerable positive cosmetic outcomes with marked clinical improvement without any recurrence, but significant adverse effects have been reported. The 1450-nm diode laser has been described to produce good (75%) clinical improvement and lesion shrinkage ranging from 50% to greater than 75% without lasting adverse effects. In our clinic, Er:YAG has provided very significant cosmetic outcomes with a low recurrence rate and minimal adverse effects. CONCLUSIONS: Laser modalities can provide satisfactory results for removing SH. It is crucial that the laser is being used by an expert who is familiar with the device as well as understand the laser tissue interaction to minimize patient adverse effects while providing the best cosmetic outcome. In our experience, Er:YAG laser can provide a safe and highly effective solution for SH.

[Neutrophilic sebaceous adenitis in a woman]. / Adénite sébacée neutrophilique chez une femme.

BACKGROUND: Neutrophilic sebaceous adenitis is a very rare disease with only three reported cases, all involving men. Herein, we describe the first case in a woman. MATERIALS AND METHODS: A 25-year-old woman presented erythematous and indurated circinate plaques on the face, upper chest and upper limbs, associated with some pustules. The eruption started immediately after sunny holidays and extended progressively with low-grade fever and axillar polyadenopathies. Blood tests showed moderately elevated neutrophils and elevated erythrocyte sedimentation rate. Cutaneous biopsy showed an inflammatory infiltrate composed of lymphocytes, histiocytes and neutrophils with perisebaceous distribution, infiltrating sebaceous glands with focal necrosis of sebocytes. Treatment consisting of topical steroid and photoprotection quickly resulted in regression of the lesions, with no relapse after two months. DISCUSSION: Classically neutrophilic sebaceous adenitis presents as erythematous and violaceous, indurated, circinate plaques with raised edges on the face and upper chest. Spontaneous regression is frequently reported. Histological examination is typical with an inflammatory infiltrate containing neutrophils with primarily perisebaceous distribution and penetrating sebaceous glands in places with necrosis of sebocytes. The aetiology is unknown but in a recent case, photodermatosis was suspected because lesions occurred every summer. This hypothesis is consistent with our observation but the presence of lesions on non-exposed areas raises questions about heat as a possible trigger factor in this disorder.

Sebaceous adenitis in Swedish dogs, a retrospective study of 104 cases.

BACKGROUND: Sebaceous adenitis (SA) is an uncommon, immune mediated skin disease in dogs. The aim was to retrospectively investigate SA in dogs in Sweden with respect to breed, sex and age distribution. A second aim was to retrospectively compare clinical signs in dogs with generalized SA and to estimate the survival after diagnosis in the English springer spaniel, standard poodle and the akita. METHODS: In total 34 Swedish veterinarians contributed with 104 clinically and histologically verified SA cases. Breed, gender and age at diagnosis were registered for each case. The degree of clinical signs at time for diagnosis and at follow-up and information about treatments, concurrent diseases and euthanasia were recorded for the springer spaniels, standard poodles and akitas using a standardized questionnaire. RESULTS: A total of 104 cases of SA were included; most cases were recorded for the springer spaniel (n = 25), standard poodle (n = 21) and the akita (n = 10). These three breeds, together with the lhasa apso and the chow-chow, were the most common when national registry data from the Swedish Board of Agriculture and Swedish Kennel Club were considered. The mean age at diagnosis was 4.8 years. The proportion of males was 61%. When the springer spaniels, standard poodles and the akitas with generalized signs were compared (n = 51), the spaniels showed significantly more severe clinical signs than the poodles at diagnosis regarding alopecia, seborrhoea, pyoderma and the overall severity of clinical signs. At follow-up, the degree of clinical signs for otitis externa and pyoderma differed significantly between the breeds. The estimated median survival time was 42 months. In dogs where data regarding survival was available at the end of the study (n = 44), SA was reported to be the reason for euthanasia in 14 dogs, whereof 7 within 24 months after diagnosis. CONCLUSION: The result of this study implicates that the English springer spaniel is a breed predisposed to SA and that it has more severe clinical signs than the standard poodle. A large proportion of the dogs (spaniel, poodle and akita) investigated regarding survival were reported to have been euthanized to great extent due to the disease.

BRAF mutations in multiple sebaceous hyperplasias of patients belonging to MYH-associated polyposis pedigrees.

The characteristics of sebaceous gland hyperplasia (SGH) consist of yellowish or skin-colored papules and nodules. Chronic sun exposure and immunosuppressed conditions are the main environmental risk factors, whereas chronological aging regulated by hormones and molecular changes are the intrinsic risk factors. We have evaluated the contribution of BRAF, K-Ras, and N-Ras mutations to the pathogenesis of SGHs in four patients belonging to three MYH-associated polyposis (MAP) pedigrees. MAP is an autosomal-recessive disease characterized by multiple colorectal adenomas and cancer. Immunohistochemistry of mismatch repair and APC proteins was performed. DNA isolated from blood lymphocytes and formalin-fixed or paraffin-embedded SGHs was PCR amplified and sequenced. In the SGH patients, we detected T1796A heterozygous substitution (V600E) in the BRAF gene. Compound biallelic germline MYH mutations (Y165C/G382D, R168H/379delC, and Y90X/delGGA464) were detected in the MAP patients. In contrast to the majority of melanocytic lesions, activating hotspot mutations in BRAF have not been involved so far in the pathogenesis of SGH. BRAF mutation is not a specific marker of melanocytic cancerogenesis, and it can also be involved in SGHs. In both melanocytic and non-melanocytic skin tumors, BRAF mutation is linked to early tumorigenesis events.

Los gránulos de Fordyce: reporte de un caso / Fordyce grains: report of a case

Se expone el caso clínico de un paciente de 67 años de edad el cual presenta múltiples lesiones papulares, redondeadas, de color amarillento, ubicadas en la mucosa de ambos carrillos (a la altura de los molares superiores y en cercanía con el conducto excretor Stenon de la glándula parótida) y en el fondo de ambos vestíbulos de la mandíbula. A estas lesiones se les dio el diagnóstico definitivo de: Gránulos de Fordyce. De igual manera, en este estudio y basándose en la bibliografía, se señalan en detalle las características clínicas e histológicas más relevantes de estas lesiones, a objeto de orientar al odontólogo en el diagnostico de las mismas para evitar que las confunda con verdaderas patologías

The clinical case of a 67 year old patient is presented. He suffers from multiple papule injuries, rounded, of yellowish color, located in the mucous of both cheeks (at the height of the superior molars and close to the Stenon excretory way of the parotid gland) and at heart of both lobbies of the jaw. These injuries were diagnosed as Fordyce Grains. Likewise, in this study and based on the literature, the clinical and histological details of these injuries are described in detail, in order to guide dentists in their diagnosis and so they do not confuse them with real pathologies.

Sebaceous adenitis in the Akita: clinical observations, histopathology and heredity.

Ninety-seven pure-bred Akitas were examined clinically and histologically for sebaceous adenitis. The diagnosis was established histologically in 23 Akitas by demonstrating an inflammatory reaction targeted against the sebaceous glands or a reduction in the number of glands. The clinical course of sebaceous adenitis in the Akita was similar to that seen in other breeds. The first skin lesions occurred mainly on the dorsal midline and ears. Compared with the Poodle, the age at first onset of the disease was more variable and the hair loss affected mainly the undercoat. The progression of sebaceous gland destruction varied between dogs and was not seen in all cases. Because bud-like sebaceous gland proliferation could be identified, it seems that regeneration of the sebaceous glands may occur. An autosomal recessive inheritance appears to be possible. Apart from a genetic background, immune-mediated factors possibly influence the onset and course of sebaceous adenitis.

Lesiones cutáneas en recién nacidos / Skin injuries in neonates

Las lesiones cutáneas en recién nacidos son frecuentes. La mayoría son banales y transitorias; sin embargo, algunas requieren seguimiento o son marcadores de otras enfermedades importantes. El objetivo de este trabajo fue determinar la frecuencia de presentación y algunas características de diferentes lesiones cutáneas en un grupo de 1.203 recién nacidos de hasta 72 horas de vida. De ellos, 91,2 por ciento presentó alguna lesión cutánea clasificada según criterios clínicos como pigmentada, vascular y otros. Los resultados mostraron mancha mongólica en 45 por ciento, nevos pigmentados en 2 por ciento y manchas café con leche en 2 por ciento. La lesión vascular más frecuente fue la mancha salmón (44 por ciento). Otras lesiones cutáneas frecuentes fueron eritema tóxico (42 por ciento) e hiperplasia de glándulas sebáceas (32 por ciento). El reconocimiento adecuado de lesiones cutáneas al momento del nacimiento es muy importante para definir pronóstico y evolución