Perceptions, Utilization, and Cost Assessment of Sebaceous Hyperplasia Treatment Modalities: A Pilot Survey.

BACKGROUND: Sebaceous hyperplasia (SH) is a common, benign but cosmetically bothersome skin condition preferentially affecting older adults. Despite multiple treatment options, there is no universally accepted first-line treatment for SH nor standard pricing for said approaches.  Methods: A survey aimed at evaluating treatment approaches and their respective costs was disseminated on the Orlando Dermatology Aesthetic and Clinical Conference email listserv.  Results: Out of 224 dermatologists who participated in the survey (response rate 9.2%), most treated patients with SH (95.98%). In-office procedures were used more than pharmacologic treatments (P=<0.05). Treatments most used by respondents included electrodesiccation (ED; 83.9%), cryosurgery (35.3%), oral isotretinoin (32.6%), and carbon dioxide (CO2) laser (19.2%). Cryosurgery and ED priced between <$200 to $400. Most reported 1 to 2 sessions to achieve lesion clearance for ED, CO2 laser, and cryosurgery. Twenty-one percent reported 3-4 sessions with cryosurgery. Chemical peels, diode lasers, and photodynamic therapy required between 2-4 sessions. Respondents indicated lesions were most unlikely to recur with ED and CO2 laser. Most dermatologists (86.39%) agreed or strongly agreed that they were exposed to new treatments methods for SH through this survey and 86.49% of dermatologists were interested in learning about treatments employed by others. CONCLUSION: SH is a common issue that presents in the dermatologist's office. These data highlight the perception that ED is the most common approach employed, associated with lower costs, and requiring fewer sessions to achieve resolution. More data is needed and wanted to better determine best practices for the management of SH.J Drugs Dermatol. 2024;23(2):29-37.  doi:10.36849/JDD.7734.

Treatment of sebaceous gland hyperplasia: a review of the literature.

BACKGROUND: Sebaceous gland hyperplasia (SGH) is a benign cutaneous proliferation of the sebaceous glands that primarily affects the elderly group and frequently appears in individuals receiving long-term ciclosporin therapy such as organ transplant recipients. In the latter group, SGHs are usually multiple in number and occur predominantly on the face. Patients may find their appearance cosmetically undesirable and, in some cases, may result in significant negative psychological impact. There is, therefore, a demand for safe and effective treatment for SGH particularly in this patient group. A variety of treatment modalities have been previously described including electrodessication,surgery, cryotherapy, oral isotretinoin, lasers, and topical photodynamic therapy (PDT). METHODS: The objective of this paper is to review the various treatment modalities for SGH. We performed a systematic literature review using the National Library of Medicine's PubMed Database, whereby we included articles that met the following criteria: published in English, not focused on SGH in rhinophyma, studies with adult sample with SGH lesions, and studies with patients with SGH related to ciclosporin. RESULTS: Our findings show that the literature is categorized according to the treatment modalities ranging from conventional techniques such as oral isotretinoin and cryotherapy to more advanced topical PDT, lasers and a combination of both. We found that effectiveness does not depend on the technique itself but instead on the number of lesions, financial cost, psychological factors, skin phototype and age. CONCLUSIONS: Our work shows that SGH can be treated effectively by customizing the treatment modality according to different parameters, while effectively maintaining clearance of SGH lesions with best cosmetic outcome.

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.

Tumor bicolor / A Two-Color Tumor

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Acne and hidradenitis suppurativa.

Acne and hidradenitis suppurativa (HS) both centre on hair follicles. They often occur together as part of the acne tetrad, but are found in distinct localizations. Acne is primarily defined by the presence of comedones and inflammatory lesions. However, in HS the intertriginous localization and chronicity play equally important roles for the diagnosis to the inflammatory lesions. Genetics, bacteria, environmental factors and innate inflammation have all been found to play a role in acne and/or HS. Surprisingly, there is little overlap between the findings so far. The genetics of acne and HS are distinct, bacteria have not been shown convincingly to play a role in HS, and the important risk factors obesity and smoking in HS cannot be easily translated to acne. The one driving factor central to both diseases is innate inflammation, most strikingly involving interleukin-1. Hence the interleukin-1 family, as already shown in autoinflammatory conditions associated with acne, could represent attractive treatment targets.

Spectrum of Hybrid Cysts and Their Clinical Significance.

A hybrid cyst is a cutaneous cyst combining different types of keratinization of those seen in the folliculo-sebaceous-apocrine unit. Previous reports found that it may be occasionally associated with Gardner syndrome. This study aimed to clarify the pathologic findings and clinical significance of hybrid cyst based on case series observations. We retrospectively reviewed patients who fulfilled the pathological criteria of hybrid cyst from 2001 to 2015. The patient profiles, clinical presentations, pathological findings, and associated diseases were analyzed by reviewing the medical records and slides. A total of 71 hybrid cysts were confirmed over the study period. There were 12 pathologic variants. The most frequent variant was combined infundibular cyst and tricholemmal cyst (22 in 71 cases, 30%), followed by infundibular cyst and pilomatricoma (14 in 71 cases, 19%). There was no significant association between sex, age, or site and the pathological type of hybrid cyst. Neither extra-intestinal manifestation nor a family history of Gardner syndrome was found in any case. Hybrid cysts could contain a variety of combinations of components from the folliculo-sebaceous-apocrine unit. No clinical significance was found between demographics and the type of hybrid cyst. No association with Gardner syndrome was identified in this case series.

Eruptive sebaceous hyperplasia as a side effect of oral tacrolimus in a renal transplant recipient.

Sebaceous hyperplasia, a benign proliferation ofsebaceous glands, has been well documented in organ transplant recipients treated with cyclosporine. Sebaceous hyperplasia has not been strongly associated with any other immunosuppressive medications. We report a case of eruptive sebaceous hyperplasia in a renal transplant recipient with no previous exposure to cyclosporine that was recently started on tacrolimus, mycophenolate mofetil, and prednisone. To our knowledge, this is the first report of eruptive sebaceous hyperplasia in a renal transplant recipient who was immunosuppressed with tacrolimus and had no prior exposure to cyclosporine.

Evaluation of the Efficacy of Cryosurgery in Patients With Sebaceous Hyperplasia of the Face.

BACKGROUND: Cryosurgery is an effective treatment for sebaceous hyperplasia, but there have been few clinical studies. OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of cryosurgery in the treatment of sebaceous hyperplasia. METHODS: Cryosurgery was performed 6 times, at 2-week intervals, with liquid nitrogen, and evaluated in 40 patients with 517 lesions ranging from 2 to 9 mm over the forehead, cheeks, and chin. All of the lesions were measured before and after the treatment. RESULTS: The mean age of the participants was 54.7 ± 8.9 years, and the male/female ratio was 21/19 (1.1). The mean time of the disease duration was 4.2 ± 3.0 years. After 6 cooling cycles, an excellent response (76%-100%) was seen in 341 patients (65.9%), a very good response (51%-75%) was seen in 102 (19.7%), a good response (26%-50%) was seen in 57 (11.1%), a poor response (1%-25%) was seen in 15 (2.9%), and no response (0%) was seen in 2 (0.4%). Age ( P = .004) and sex ( P < .0001) were independent predictors of an excellent response. The excellent response rates were 71.4% for males, 61.8% for females, 70.4% for ages older than 55 years, and 61.8% for ages younger than 55 years. Temporary hyperpigmentation was found in 5 lesions (0.96%), and recurrence was not seen at the 4-month follow-up. CONCLUSIONS: The well-aimed and controlled used of cryosurgery is an effective method for treating significant cosmetic disfigurement in patients with sebaceous hyperplasia. It is a low-cost therapy without scarring, hypopigmentation, or recurrence.

Genital folliculo-sebaceous cystic hamartoma: A claim of the stroma as a clue in the diagnosis of proliferations with follicular differentiation.

Folliculo-sebaceous hamartomas comprise a series of entities whose boundaries are imprecise. We present the clinical case of a folliculo-sebaceous cystic hamartoma of genital localization where the diagnosis was established based on the epithelial proliferation, but mostly, on the characteristic stroma. Because this lesion lacked of the cystic component, we mention the most frequent differential diagnoses and review the literature of the few cases published on this infrequent localization.

Two cases of genital neutrophilic sebaceous adenitis.

Sebaceous glands without a follicular structure are present in the eyelid margin (meibomian glands), lip, glans penis and vulva. Inflammatory disease of a sebaceous gland lacking follicles is rare, except for meibomitis. We report the first two cases of vulval sebaceous adenitis. Painful, yellowish-orange papules/nodules recurred at the vulval mucocutaneous junction or mucosa during the luteal phase of the menstrual cycle. Histopathologically, a dense neutrophilic infiltration was observed within the sebaceous ducts. In both cases, oral minocycline improved the condition. They had been treated with antiherpetic agents. It is possible that women diagnosed with recurrent genital herpes have genital neutrophilic sebaceous adenitis.

Nevus sebaceus: a clinicopathological study of 168 cases and review of the literature.

BACKGROUND: Nevus sebaceus is a hamartoma composed of abnormal epidermal and dermal components with clinical and histopathological features that change with aging. Prophylactic excision of the lesion was advised historically considering its potential for giving rise to malignant tumors. However, whether early prophylactic excision should be performed has been questioned recently as most of the tumors have been found to be benign in origin. METHODS: The histopathologic features of 168 patients with nevus sebaceus were reviewed to determine the frequency of different histologic features as well as associated neoplastic growths. RESULTS: Acanthosis, papillomatosis, and basal layer pigmentation were the most frequent findings. Hyperplastic changes of the sebaceous glands became obvious during the second decade and were present in 60% of the specimens from individuals older than 20. Inflammatory infiltrate was almost invariably present. Skin adnexal changes were frequently noted, including sebaceous gland hyperplasia (93.5%) and primitive hair follicles (76.8%). In 88.5% of scalp lesions, markedly decreased terminal hair was observed. Ectopic apocrine glands were present in 55.4% of specimens, while 24.4% showed anomalous ductal sweat gland structures resembling eccrine hyperplasia. Neoplastic changes were detected in nine cases, including four trichoblastomas, three tricholemmomas, and two syringocystadenoma papilliferums. CONCLUSION: Development of malignancies in sebaceus nevi is a rare phenomenon, and decision for excision of the lesion should be made after thorough evaluation of the pros and cons.

Diffuse sebaceous-gland hyperplasia.

Diffuse sebaceous-gland hyperplasia is a rarevariant of sebaceous-gland hyperplasia that isdistinct from the well-known circumscribed type.The term presenile sebaceous hyperplasia has beenutilized to describe this entity that is distinguishedby specific features, which include confluence oflesions that results in the formation of large plaqueson the face, the sparing of periorificial regions, andhighly functional glandular hyperplasia that resultsin excessive sebaceous secretion. We present a43-year-old woman with monomorphous, skincoloredand yellow, smooth 1- to-3-mm papules,some with central umbilication, that spare theperiorificial zones. Histopathologic examination wassuggestive of diffuse sebaceous-gland hyperplasia.Differential diagnosis of this condition is broad andincludes syndromes that are associated with multiplefacial papules and malignant conditions, such asMuire-Torre syndrome and Cowden syndrome. Itis important to be aware of this condition in orderto consider appropriate treatment options, such asisotretinoin and to avoid unnecessary diagnostictests.