Monday, May 25, 2020

Sebaceous Hyperplasia: Causes and Treatments

It occurs both in on men and women.  Papules rarely occur before the age of 30 become increasingly more common with advanced aging. Sebaceous hyperplasia happens when the sebaceous gland.   Sebaceous glands secrete an oily, waxy substance consisting of fats and cellular debris, called sebum.  It’s purpose it to lubricate the surface of the skin. The sebaceous gland becomes enlarged with trapped sebum, thus causing lesions on the skin Although there are sebaceous glands all over the body, and the lesions can form almost anywhere.  

They are shiny and usually appear on the face, especially the forehead, cheeks and nose. They’re also small, normally between 2 and 4 millimeters wide.  They can be yellowish orange colored and have a slight indentation in the center and a white or yellow outer edge.   Typically, they are painless and do not itch. Sometimes you can see tiny blood vessels (telangiectasia) in the bump as well. The etiology of sebaceous hyperplasia is unknown, but genetic inheritance plays a large role.    However, it is suggested that sun damage plays a contributing factor. 


You cannot get rid of sebaceous hyperplasia by squeezing it. There I nothing to extract from the bump because it doesn’t have a comedonal core.  You’ll only cause them to become inflamed or bleed.  Or, they may also bleed if you shave over them.  There is currently no cure for sebaceous hyperplasia    Is sebaceous hyperplasia a skin disease?  No.  Sebaceous hyperplasia is purely a cosmetic concern. The lesions are  benign, not contagious or cancerous.  They are not a precursor to skin cancer like other skin lesions such as actinic keratosis.   Can anyone get sebaceous hyperplasia? It is more common in middle-aged and older people, but they can show up at any age.  Some people get sebaceous hyperplasia at a much earlier age if there is a strong family history of it, however, it is rare.  Roughly 80% of people over the of age of 70 have at least one lesion. People with fair skin — especially people who’ve had a lot sun exposure — are more likely to get it. 

Sebaceous hyperplasia affects both men and women about equally. It's seen most often in people with light or fair complexions.

Contributing factors to the development of sebaceous hyperplasia

One:

There’s a genetic component. It tends to be genetically predetermined and there is usually a family history of sebaceous hyperplasia. If someone in your family has sebaceous hyperplasia, you're more prone to developing it too, because It is an inherited tendency.

Two:

The condition is also much more common in those taking the immunosuppressant medication cyclosporine long-term, may have a higher risk of developing sebaceous hyperplasia; such as people who have had a transplant.

Three:

Newborns can develop this condition they are a natural response to the maternal hormones of pregnancy and the bumps usually recedes and disappear on their own within a few weeks as maternal hormones dissipate.

Four:

Another theory is, reduced androgen levels. The natural aging process causes a reduction of androgen hormones.

Androgen hormones, particularly testosterone, play a fundamental role in our sebaceous glands, such as stimulating the sebaceous glands to create more oil.

Here’s how is works. An increase in androgen hormones causes an increase sebaceous gland activity. For example, during puberty, there is a huge increase in androgens. Thereby producing oily type skin.


The decrease in androgen hormones, not only slows down sebaceous gland activity, there’re also a decrease in the natural cell turnover rate within the sebaceous glands.

As a result, cells back up within the gland, producing an excess of skin cells and swelling of the sebaceous gland

How can you prevent Sebaceous Hyperplasia?


Because there is not a definitive cause for sebaceous hyperplasia, a prevention plan that will be 100 percent effective cannot be determined. The best way to avoid developing this condition is by maintaining a healthy diet, lifestyle, and skin care routine that includes retinol, salicylic acid and sun protection.


1. Prevent glands from clogging.

If your skin type and family history makes you inclined to develop sebaceous hyperplasia, use a facial cleanser with the ingredient salicylic acid or low levels of retinol products to help prevent your sebaceous glands from clogging.

Taking preventive steps can minimize their appearance and perhaps reduce the risk of their formation.

2. Reduce sun exposure

Research has shown sebaceous hyperplasia is linked to sun exposure. Yet another excellent reason to wear sunscreen. Use a broad spectrum sunscreen with an SPF of at least 30 and wear a hat to protect your scalp and face. Remember to wear your sunscreen even on cloudy days. NEVER…...leave home without it.

Sebaceous Hyperplasia Treatments

Retinol

Prescription retinoid (Retin A) is often recommended for people with sebaceous hyperplasia, an option that temporarily shrinks the sebaceous glands. It order for it, work it needs to be applied consistently for about for about two weeks.

This treatment method is not permanent solution. Sebaceous hyperplasia returns when you discontinue using Retin A, usually about a month after stopping treatment.

To avoid the side effects of the prescription form of retinoids, consider using daily retinol. Applying a daily retinol serum can help reduce or prevent your sebaceous glands from clogging.
 
Direct High Frequency  (Skin Classic treatment)

High frequency is a quick and simple office-based technique where an electrical current 

A needle-shaped electrode is used to deliver a high frequency electric current to super heat a pinpointed area of the skin. The pen-like device is placed close to the skin so that electricity can flow to and heat the targeted area.

The current dries out cells that are not wanted on the skin’s surface .A scab will form that eventually falls off in a few days.

It's a very safe procedure and serious complications are extremely rare. Even though, direct high frequency provides 100 percent removal, but there is no guarantee that another lesion will not develop over time.

Chemical peels

Facial peels containing chemicals such as salicylic acid or trichloroacetic acid (TCA). Chemical peels may temporary cause irritation, redness, and sensitivity. This can aggravate sebaceous hyperplasia if a person does not follow-up with proper aftercare and sun protection. This method does require multiple monthly applications to each lesion.

Salicylic Acid–penetrates deep into the pore, infiltrating the oil buildup to unclog impactions.

Trichloroacetic Acid-a chemical peel that induces exfoliation of the skin.

Laser therapy

A healthcare professional can use a to smooth the top layer of your skin and remove the trapped sebum from the gland using a laser. Smoothing the appearance of bumpy skin. As a cautionary step, laser therapy should be tested on a small area of skin as a safeguard to ensure you don’t have any adverse reaction.


Cryotherapy


Sebaceous hyperplasia lesions are removed by a process called cryotherapy. The treatment involves the use of liquid nitrogen, although carbon dioxide and argon may also be used. A healthcare professional can freeze the lesion, causing it to dry up and drop away. Some people may experience a temporary discoloration in the area. 

Electrocautery

This involves using a charge of electricity to burn the lesion. A fine-needle with an electrical charge heats and vaporizes the lesion. The skin will then scab over and fall away, leaving behind a smooth area. It may also cause some discoloration in the affected area. Special care is used during treatment, because the scabs can leave discolored marks during the healing process.

Occasionally, slightly lighter or darker pigmentation may occur in the treated areas, this usually resolves over time. Darker pigmentation can be lightened with a melanin inhibitor serum or cream This is a painless procedure that may or may not require local numbing injections.

Photodynamic therapy


Photodynamic therapy involves pre-treating the lesion with a photosensitizing prescription drug like, gel (5-aminolevulinic acid (ALA). Then exposing the area to a strong light source which kill the cells. The light source could be either blue light laser or IPL. The skin may become extremely sensitive after treatment, leading to redness, irritation, and some peeling.  Multiple treatments may be required.


Radio-Frequency treatments

Radio Frequency (RF) involves heating the sebum or transmitting a Radio high-frequency current that penetrates the skin to vaporize the lesions. New sebaceous hyperplasia can appear, though previously treated lesions do not normally return. The skin may feel tender or bruised following the treatment, but the side effects are temporary.
Surgery

If sebaceous hyperplasia is severe or persistent, the lesions can be removed surgically, preventing them from returning. Depending on the number of lesions and the scarring response of the skin, surgical removal should be the last resort, because it may cause scarring. 
 
Isotretinoin


The prescription medication called isotretinoin is effective in reducing the size of the sebaceous gland and suppressing the production of sebum, however, the side effects of the mucosa and skin dryness may not be tolerated well by some people. 

Antiandrogen medications

There may be a link between sebaceous hyperplasia and increased testosterone. For women with severe symptoms and don’t respond well to other removal methods, some doctors may recommend antiandrogen medications.  Antiandrogen prescription medications lower testosterone.

Warm compres


Applying a warm compress or washcloth soaked in warm water on the bumps can help dissolve buildup. While this won’t get rid of sebaceous hyperplasia, it can make the bumps smaller and less noticeable.





 
References Sources:
Medicalnewtoday  https://www.medicalnewstoday.com/articles/321550.php
Berman Skin Institute. https://www.skinmds.com/skin-disorders/sabeceous.htm
Repeated salicylic acid peels for the treatment of hyperplastic sebaceous glands in hypohidrotic ectodermal dysplasia  https://www.ncbi.nlm.nih.gov/pubmed/25065417
70% Trichloroacetic Acid in the Treatment of Facial Sebaceous Hyperplasia  https://www.researchgate.net/publication/329629136_70_Trichloroacetic_Acid_in_the_Treatment_of_Facial_Sebaceous_Hyperplasia
Sebaceous hyperplasia: systemic treatment with isotretinoin    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371670/
Sebaceous hyperplasia and androgen levels-still controversial  https://www.endocrine-abstracts.org/ea/0049/ea0049ep811
Treatment of sebaceous gland hyperplasia by photodynamic therapy with 5-aminolevulinic acid & a blue light source or IPL light source.   https://www.ncbi.nlm.nih.gov/pubmed/15624735
Sebaceous Hyperplasia: Gaining the Upper Hand on those Little Lesions  https://www.dermascope.com/disorders/9481-sebaceous-hyperplasia-gaining-the-upper-hand-on-those-little-lesions



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