Sebaceous Hyperplasia
- Best Results1-2 sessions
- Treatment Recovery3-7 days
- Procedure Time30-60 minutes
- Skin SpecialistLaser nurse
- Duration of ResultsYears+
- AnaestheticNumbing cream
- Back to Work3-7 days
- Cost$$
Sebaceous Hyperplasia
Sebaceous hyperplasia is a common benign condition that presents as raised, persistent lumps & bumps on the face. It is more common with age & sun exposure. This condition is resistant to creams, including retinol, however, is easily treated with laser resurfacing.
FactsFacts on Sebaceous Hyperplasia
- These are common lumps & bumps that occur in middle age
- Sebaceous hyperplasia often effects the cheeks & forehead areas
- These spots are non-cancerous
- Treatment is elective
- Numbing gel is used prior to laser as it ensures patient comfort levels
- Most people only require one treatment
- These lesions will recur over time
- Retinoids can reduce recurrence
- Laser ablation gives the best results
What is Sebaceous Hyperplasia?
Sebaceous hyperplasia is a benign, non-cancerous lesion that is frequently seen in middle-aged men & women. They start off as single lesions & multiply over time. The most frequent sites include the forehead & cheeks.
Clinically they start off as small yellowish spots & dots. Over time they become raised papules with petals & a central dell. They frequently have blood vessels within them. They will not turn into cancer (unlike basal cell cancers or rarer tumors with sebaceous differentiation). Treatments are elective.
What is the best way to treat them?
Laser ablation is the fastest, most efficient way to treat these lesions. I normally use an ablative erbium or CO2 laser in fully ablative mode, not fractional.
One treatment will address over 90% of these lesions. Your skin will take 4-7 days to heal up following laser ablation. The area may be red for 2-3 weeks post laser. Other lasers that can help include the Gemini laser using the 532 wavelength with the cooler turned off. Simple hyfrecation can give good results.
How long does it take to laser sebaceous hyperplasia?
Typically use numbing gel for one hour, followed by laser. Each lesion takes approximately 5 to 10 second to treat. We can address 60 -80 lesions within 10 minutes.
In most cases we use two types of lasers, one for the individual areas of sebaceous hyperplasia and the other for treatment of general sun damage. This may take an additional 15 to 30 minutes to perform.
What other treatments can reduce sebaceous hyperplasia?
Other treatments include –
- Pinpoint hyfrecation with a needle tip. Each ‘petal’ or bud is zapped with a needle.
- TCA 35 to 50% focal chemical peel.
- Cryotherapy can be used in caution if you know what you are doing. Often best with a cotton stick applicator compared to conventional & convenient spray and blast. The latter often leaves white spots or even scarring.
- PDT or photodynamic therapy can help. This treatment is best used for DVA patients as it is covered. In most cases I prefer lasers as PDT does not individually address these spots. It can globally improve 30 to 70% of sebaceous hyperplasia lesions. PDT is best employed to treat background sun damage.
- Punch excision or formal surgical excision of lesion. This may be indicated if the other diagnoses are considered. These methods can obtain pathology (microscope viewing) to exclude skin cancers such as basal cell carcinoma or sebaceous adenomas/carcinomas (or BBCs with sebaceous differentiation).
Lasers ,peels, focal diathermy, oral vitamin A & pin point hyfrecation can all treat sebaceous hyperplasia.
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Will they come back?
Yep. They will return over a period of time, typically over 3-5 years. In some cases earlier, in others later. Topical retinoids can in theory reduce recurrence. Oral retinoids in practical terms provide the most predictable results.
Discuss with your dermatologist ways to reduce recurrence. Note: my work involves procedural dermatology, I do not prescribe medications. For medical management of sebaceous hyperplasia, infrequent blood tests are required. You should be under the management of a dermatologist who can follow this up.
What are other conditions that look like sebaceous hyperplasia?
This lesion is most frequently confused with basal cell carcinomas or BCCs. Carcinomas usually lack the central dell that is pathognomonic of sebaceous hyperplasia.
Dermatologists can often tell the difference between these lesions with the aid of a dermatoscope. A biopsy can be helpful in some cases.
Sebaceous hyperplasia are non cancerous ‘spots & dots’ that is frequently encountered in the early 40s. It can be often confused with a BCC, however clinical & dermatoscopic examination can tell the difference
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🔍Magnified: yellowish papules with lobules-rosettes & a central dell
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👍🏻🔍Dermatoscopic: as above, with fine telangiectasias (blood vessels) that don’t cross the center of the lesion, but form a crown peripherally. Lobular structures constitutes the ‘cumulus clouds ☁️’ sign
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🔬Dermatoscopes we use Delta One, Delta 30 by Heine @heineoptotechnik
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🔫Treatment: straight forward. Laser is the fastest, TCA at 50+%, or simple diathermy or hyfrecators all work well
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💊Retinoids: Oral over topical. Low dose isotretinoin does the trick
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😎Dr Davin Lim
Brisbane🇦🇺
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#diyskincaretips #skinclinic #sebaceoushyperplasis #co2laser #drdavinlim #dermatologybrisbane #skinscience #dermresidency #dermresident #heine
#dermatoscopy
Retinoids are one of the most widely prescribed drugs for treating skin conditions. Uses include acne & anti aging all the way to genetic disorders of cell turnover
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🔬Skin science: Retinoids exert their power through interactions with retinoid receptors known as RAR or retinoic acid receptors. In the skin, gamma is the most prevalent, hence why I have changed my prescription habits & favor a fourth generation retinoid called trifarotene (gamma specific retinoid)
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👍🏻Tips: start with an OTC formulation. Retinol 0.5-1% is a good starting point. From there understand your skin’s threshold & know how to modulate & optimise topicals 💯
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📖My practice: I prescribe topical retinoids to a small minority of patients (in the context of anti-aging), usually post laser or deep chemical peels. Your dermatologist may have a different algorithm. Prescription retinoids are tricker to use cf OTC, but with a sensible approach, most people will work it out. More on how to use in next week's post
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#retinoids #retinol #skinscience #skincarecommunity #retinoicacid #skincaretips #drdavinlim #dermatologistbrisbane
Can retinol creams reduce the bumps?
In theory yes, in actual application, no. Retinoids taken orally can reduce sebaceous hyperplasia; however over the counter retinol (and even prescription retinoids) have little impact on established lesions.
Most dermatologists prescribe tretinoin or adapalene to reduce background photoaging in the hope that topical retinoids can slow down new lesions.
Can tablets help?
Yes. Oral Accutane or isotretinoin can make a big difference in most patients. This therapy is indicated if there are extensive lesions, or in cases of sebaceous adenomas.
The usual dose ranges between 5 to 10 mg a day. This medication can be prescribed by a medical dermatologist. Careful monitoring is mandatory.
In some cases, antiandrogens can be used in female patients.
Disclaimer: I do not prescribe for sebaceous hyperplasia, please discuss medical treatments with your treating dermatologist.
Who to see to have this treated?
Book a consultation with your dermatologist. Alternatively, my laser nurses at Clinic Cutis can use ablative CO2 or erbium lasers to individually treat these spots.
Disclaimer: My work involves management of difficult conditions & or procedures. For simple spots & dots as well as facial veins & redness, please book a consultation with my procedural nurses.
What factors predispose people to sebaceous hyperplasia?
- Age: they occur with increasing age. Starts in the 30s, adds up over the decades.
- Genetics: many have a family history of sebaceous hyperplasia. Some do not.
- Immune suppression: especially post-transplant patients.
- Genodermatoses: really rare stuff like Muir Torre syndrome.
Any home treatments for sebaceous hyperplasia?
Very early lesions can be treated with high strength salicylic acid. Application of wart kill with a toothpick can be highly effective for small lesions.
Most patients apply too much, resulting in collateral damage to the surrounding skin. DIY treatments are not recommended if you are concerned about facial scarring and or pigment changes. Best see a professional.
Does Medicare cover treatment for sebaceous hyperplasia?
It used to, until 3 years ago. The current Medicare guidelines formally excludes this condition from treatment.
There are strict guidelines that often change from year to year. Treatment for skin conditions favour lighter skin types, with the suggestion of the White Australia policy of the 1960. For example, red lesions including blood vessels seen at 3 meters are partially covered (using specific wavelengths of lasers). Pigmented lesions are not covered. Ablative lasers can be used on fair skin, but not darker skin type 5.
Davin’s Viewpoint on Sebaceous Hyperplasia
This condition is very common, especially in Queensland. Most appear before the age of 40. Traditionally dermatologists have treated these with topical retinoids including retinol, tretinoin/retinoic acid, adapalene & tazarotene. Though useful for treating related sun damage, these lesions are usually refractory to topical modalities.
Simple laser ablation using a spot size of 2 to 2.5 mm is the fastest most effective way to address sebaceous hyperplasia. Downtime of less than a week. Book to see my senior laser nurses for management.
Disclaimer: I do treat these lesions on an incidental basis when I perform bigger cases such as fully ablative laser resurfacing. I do not use the laser theatre to treat these lesions specifically.
