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SynopsisSebaceous hyperplasia is not a true neoplasm but rather the result of localized hypertrophy of the sebaceous glands. Sebaceous hyperplasia usually occurs on the central face, most prominently the forehead. It presents as solitary or, more often, multiple skin-colored to yellow papules of 2-5 mm (or more) that usually exhibit a central dell corresponding to the patulous follicular infundibulum. A peripheral "crown" of telangiectatic vessels is often observed with dermoscopy.
Classically, sebaceous hyperplasia affects middle-aged to older adults, where it is seen in more than 25% of individuals. It also has been noted to rarely occur in the peripubertal and young adult age group, often in a familial pattern.
Sebaceous hyperplasia may also be present on the nipples, where it is referred to as Montgomery's tubercles, and on anogenital regions of the foreskin, penile shaft, scrotum, and vulva, where the differential diagnosis would include molluscum contagiosum and human papillomavirus (HPV).
Juxtaclavicular beaded lines (JCBL) is a unique presentation of sebaceous hyperplasia presenting as small (0.5-1.5 mm), slightly yellow papules in a linear pattern occurring in lines of cleavage localized to the low neck and juxtaclavicular areas. Unlike classic sebaceous hyperplasia, this condition presents earlier in life, starting during or just after puberty.
Sebaceous hyperplasia is seen in up to 30% of renal transplant patients receiving cyclosporin as immunosuppression and is also reported to affect heart and hematopoietic stem cell transplant recipients. Recently, the related immunosuppressant tacrolimus has been associated with the development of sebaceous hyperplasia as well.
Sebaceous hyperplasia is benign, and treatment is for cosmetic purposes, although, in rare cases, eruptions can be severe and disfiguring.
Related topic: Sebaceous hyperplasia in newborn
L73.8 – Other specified follicular disorders
238748009 – Sebaceous hyperplasia
Differential Diagnosis & Pitfalls
- Milia – Primary differential in sebaceous hyperplasia of the newborn. Also common in middle-aged adults and older. Tend to be smoother and smaller yellow / white papules without central dell.
- Dermal nevus (see common acquired nevus) – Intradermal nevi tend to be more skin colored, and there is no lobularity or central umbilication.
- Flat wart – Not as limited to the facial and genital areas as typical sebaceous hyperplasia.
- Fibrous papule
- Fordyce spots (visible, prominent sebaceous glands of mucosa)
- Basal cell carcinoma – Best differentiated with magnified examination (dermoscopy): small clusters of gland structures surrounding the follicle are not seen, and telangiectactic vessels (arborizing) tend to occur freely over the surface, as contrasted to the more peripheral "crown" vessels of sebaceous hyperplasia lesions.
- Molluscum contagiosum (adult, child) – May also be seen in the face and genitals; firm papular lesions are more exophytic and pearly with a core at the summit. (Enhance visualization of core with light liquid nitrogen freeze.)
- Xanthoma (eg, eruptive xanthoma)
- Calcifying epithelioma of Malherbe
- Lupus miliaris disseminatus faciei
- Rhinophyma – Unique rosacea-associated sebaceous hyperplasia of the nose.
- Colloid milium
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Patient Information for Sebaceous hyperplasia
OverviewSebaceous hyperplasia is a common harmless enlargement of the skin oil glands.
Who’s At RiskIt usually occurs in middle-aged and older adults and is seen in about 1% of the US population.
About 10-16% of people on long-term cyclosporin A for organ transplants also develop sebaceous hyperplasia. There are a few families where multiple lesions begin to occur during puberty.
Signs & SymptomsLesions may be single or multiple. They are seen in areas where many oil glands are found - the face (nose, cheeks, and forehead), chest, upper arms, mouth lining, vulvar area, and around the nipples.
They are small (2-9 mm), painless, whitish-yellow-to-pink or skin-colored bumps, often with a central depression or dimple.
Self-Care GuidelinesNo treatment is required. They will not go away on their own.
When to Seek Medical CareSee your doctor:
- If the lesions are irritated (by shaving, glasses, or clothing) or if they are cosmetically bothersome.
- If you have many lesions (over 10) or if they are growing or bleeding.
TreatmentsIf there is doubt about the diagnosis, a biopsy may be done.
Many types of treatment can remove the lesions, with a small risk of leaving scars:
- Burning (cautery)
- Freezing (cryosurgery)
- Applying topical chemicals
- Applying a drug activated by light (photodynamic therapy)
- Laser treatment
- Cutting out the lesions (excision)
Bolognia, Jean L., ed. Dermatology, pp.546-547, 1743. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.2541. New York: McGraw-Hill, 2003.