Sebaceous hyperplasia (SH) is a common, non-cancerous skin condition resulting from the enlargement of the skin’s oil glands. These growths are benign and generally pose no health risk, but many individuals seek treatment for cosmetic reasons. The condition appears when sebaceous glands, which produce the oily substance sebum, become overactive and blocked, leading to visible bumps. Effective management requires understanding both in-office procedures and at-home maintenance strategies.
Understanding Sebaceous Hyperplasia
Sebaceous hyperplasia appears as small, soft, dome-shaped bumps, typically measuring two to five millimeters. These lesions are usually yellowish or flesh-colored and often display a characteristic central indentation, which is the opening of the hair follicle duct. The condition is caused by an overgrowth of sebocytes, the specialized cells that make up the sebaceous glands, leading to an enlarged gland structure.
This sebocyte overgrowth is often linked to the natural aging process and hormonal changes, particularly the decrease in male sex hormones (androgens) that occurs later in life. This decline slows the turnover of sebaceous cells, causing them to accumulate and enlarge the gland. Key risk factors include middle and older age, genetics, fair skin, and long-term immunosuppression (e.g., in organ transplant recipients taking cyclosporine).
In-Office Treatment Options for Removal
For immediate and complete removal, in-office procedures that physically destroy or excise the enlarged gland are generally the most effective options. Electrocautery (electrodessication or thermal cautery) is a highly effective method. This procedure uses a fine electrical needle to deliver a high-frequency current, generating heat to precisely destroy the hyperplastic tissue. The treated area forms a small scab that heals within five to ten days, often resulting in minimal scarring.
Laser therapies offer another powerful method, particularly for patients with multiple or widespread lesions. The Carbon Dioxide (\(\text{CO}_2\)) laser ablates the tissue by vaporizing the enlarged gland, yielding significant cosmetic improvement, often in a single session. While highly effective, ablative lasers require careful use due to a potential risk of scarring or temporary pigment changes. The Pulsed Dye Laser (PDL) targets the blood vessels feeding the sebaceous gland, causing it to shrink, and has been noted for its safety profile.
Photodynamic Therapy (PDT) is a two-step process that can treat multiple lesions simultaneously and is effective at reducing sebaceous gland activity. A photosensitizing agent, such as 5-aminolevulinic acid (ALA), is applied to the skin and absorbed selectively by the sebaceous glands. The area is then exposed to a specific light source, which activates the agent to destroy the targeted cells. This method is less invasive than ablative procedures and results in minimal downtime, although multiple sessions are typically necessary.
For larger, isolated lesions, a minor surgical procedure called shave excision may be performed. This involves using a blade to carefully remove the lesion so it is flush with the surrounding skin. While effective for deeply rooted bumps, shave excision carries a slightly higher risk of leaving a small scar or indentation compared to electrocautery or laser ablation. Electrosurgery and laser ablation are often preferred due to their precision and lower risk of visible scarring.
Topical Maintenance and Preventing Recurrence
Topical treatments are important for maintenance and preventing new lesions after clinical removal, as the underlying tendency for sebaceous glands to enlarge persists. Topical retinoids, such as prescription-strength Tretinoin, are a primary maintenance strategy. These vitamin A derivatives normalize cell turnover and reduce sebum production, helping to keep hair follicle ducts clear and minimizing the chance of new bumps forming.
Salicylic acid, a beta-hydroxy acid, is another useful topical agent, often used in chemical peels. Being oil-soluble, salicylic acid penetrates the pore lining where it exfoliates dead skin cells and reduces the buildup of trapped sebum. Professional-strength peels can reduce the appearance of existing lesions and are often performed in a series of treatments. Azelaic acid is also sometimes used for its anti-inflammatory and cell-regulating properties, which can help manage the condition and reduce associated redness.
These topical agents are rarely definitive treatments for established lesions but can reduce their size and are crucial for long-term control. Recurrence is a significant challenge, as the tendency for gland enlargement remains even after successful removal. Therefore, maintenance therapy is often required indefinitely to keep the skin clear. Sun protection is also an important lifestyle factor, as long-term sun exposure is thought to contribute to the condition’s development.