Sebaceous Gland Hyperplasia – Causes, Symptoms and Treatment

What Is Sebaceous Gland Hyperplasia?

Sebaceous gland hyperplasia is a benign, non-contagious skin condition in which one or more sebaceous glands become abnormally enlarged. Sebaceous glands are small glands in the skin that produce sebum – an oily substance that keeps the skin moisturized and protected. In hyperplasia – meaning an excessive increase in cell number – these glands grow larger than normal without becoming cancerous.

The condition is most commonly seen in middle-aged and older adults and is a frequent finding in dermatological practice. Although it poses no health risk, it can be a source of cosmetic concern for many patients.

Causes

The exact cause of sebaceous gland hyperplasia is not fully understood, but several contributing factors have been identified:

• Hormonal influences: Androgens (male sex hormones such as testosterone) stimulate sebaceous glands and can promote their excessive growth. This explains why the condition is more frequent in men and individuals with elevated androgen levels.
• Skin aging: As the skin ages, it loses elasticity and sebaceous glands can become enlarged. The condition is therefore particularly common in people over the age of 40.
• Long-term use of ciclosporin: The immunosuppressant ciclosporin, used after organ transplantation, is associated with an increased occurrence of sebaceous gland hyperplasia.
• Genetic predisposition: A familial clustering has been observed, suggesting a hereditary component.
• UV radiation: Chronic sun exposure may contribute to the development of the condition, as UV radiation causes long-term changes in the skin and its structures.

Symptoms and Clinical Presentation

Sebaceous gland hyperplasias typically present as single or multiple soft, yellowish-white to skin-colored papules. Their characteristic features include:

• Size: usually 2 to 9 millimetres in diameter
• Shape: round to oval, with a central umbilicated depression (central dell)
• Surface: smooth with a slightly waxy or shiny appearance
• Location: predominantly on the face, especially the forehead, nose, cheeks, and temples; less commonly on the neck, chest, or back
• Palpation: soft and non-tender

The papules are generally asymptomatic, meaning they do not cause pain, itching, or inflammation. Mild redness or minimal irritation may occasionally occur.

Diagnosis

The diagnosis is made in most cases clinically through careful visual inspection of the skin. An experienced dermatologist can identify sebaceous gland hyperplasia based on its typical appearance – particularly the characteristic central depression and yellowish coloration.

Dermoscopy

Dermoscopy (dermatoscopy or epiluminescence microscopy) is a non-invasive examination technique in which the skin is assessed using a handheld magnifying device with a light source. Typical dermoscopic features of sebaceous gland hyperplasia include cauliflower-like yellowish-white lobules and crown-shaped vessels arranged at the periphery of the lesion.

Histological Examination

In ambiguous cases or to distinguish the condition from other skin lesions – particularly basal cell carcinoma (a form of skin cancer that can appear similar) – a tissue biopsy may be performed and examined under a microscope. Histologically, the condition shows a proliferation of mature sebaceous lobules surrounding a centrally dilated sebaceous duct.

Treatment

Since sebaceous gland hyperplasia is benign and carries no health risks, treatment is not medically necessary. It is usually performed at the explicit request of patients for cosmetic reasons. The following treatment options are available:

Physical and Laser-Based Procedures

• CO2 laser or erbium-YAG laser: Targeted laser treatment that vaporizes the enlarged sebaceous gland. Considered one of the most effective and gentle methods.
• Electrosurgery (electrodesiccation): Removal of tissue using electric current. Easy to perform, but carries some risk of scarring.
• Cryotherapy: Freezing the papule with liquid nitrogen. Less precise and may require multiple sessions.
• Photodynamic therapy (PDT): Use of light-activating substances combined with specific light to destroy the glandular tissue.

Medical Therapy

• Topical retinoids: Creams or gels containing vitamin A acid derivatives (e.g., tretinoin) can reduce sebaceous gland activity and improve the appearance of lesions.
• Oral isotretinoin: In more severe or widespread cases, systemic isotretinoin (a potent retinoid) may be considered, but only after careful risk-benefit assessment due to its side effects.

Surgical Excision

Surgical removal is possible but is rarely chosen as a first-line option due to the risk of scarring.

Differentiation from Other Conditions

It is important to distinguish sebaceous gland hyperplasia from other skin conditions, some of which may be more serious:

• Basal cell carcinoma: A malignant skin tumor that can also present as a pearly, shiny papule – differentiation is essential.
• Milia: Small, white cysts that lack a central depression.
• Xanthomas: Yellowish fatty deposits in the skin, usually associated with lipid metabolism disorders.
• Fibromas and sebaceous cysts: Other benign skin tumors with different clinical appearances.

Prognosis

Sebaceous gland hyperplasia is a harmless, chronic skin condition. Without treatment, the papules typically grow slowly or remain stable over time. Recurrence after treatment is possible, particularly if the underlying triggers – such as hormonal influences or causative medications – remain present.

References

1. Zouboulis CC et al. - Sebaceous gland diseases. Journal of the German Society of Dermatology, 2014.
2. Vergilis-Kalner IJ, Goldberg LH - Sebaceous hyperplasia: treatment with 1720-nm diode laser. Journal of Drugs in Dermatology, 2011.
3. Plewig G, Kligman AM - Acne and Rosacea. Springer Verlag, 3rd edition, 2000.