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PATIENT STORY

A 65-year-old man noted a new growth on his face for 1 year (Figure 165-1A). On close examination, the growth was pearly with a few telangiectasias. The donut shape and presence of sebaceous hyperplasia scattered on other areas of the face were reassuring that this is likely a benign sebaceous hyperplasia. To confirm our clinical impression, the lesion was examined with a dermatoscope (Figure 165-1B). Vessels extending toward the center of the lesion from the periphery but not crossing the center (like the shape of a crown) were seen. This along with the yellow color of the sebaceous glands strongly supported the diagnosis. Because the patient wanted the lesion to be removed, a shave biopsy was performed to completely rule out basal cell carcinoma (BCC). The patient was happy with the cosmetic result and relieved that the pathology showed sebaceous hyperplasia.

FIGURE 165-1

A. Large single lesion of sebaceous hyperplasia that was examined by dermoscopy to confirm that it was not a basal cell carcinoma. B. Typical features of sebaceous hyperplasias were seen (crown vessels among yellow sebaceous glands). (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

Sebaceous hyperplasia (SH) is a common, benign condition of sebaceous glands consisting of multiple asymptomatic small yellow papules with a central depression. The sebaceous lobules of SH are greater in number and higher in the dermis than normal sebaceous glands, and only 1 gland appears enlarged.1 Consequently, the term hyperplasia appears to be a misnomer, and SH is more accurately classified as a hamartoma (disorganized overgrowth of tissue normally found at that site).1

EPIDEMIOLOGY

  • SH occurs in approximately 1% to 26% of the adult population; the latter number is from a population study of hospitalized patients with a mean age of 82 years.1

  • The prevalence of SH is increased in those with immunosuppression by 10-fold to 30-fold1; for example, 10% to 30% of patients receiving long-term immunosuppression with cyclosporine have SH.2,3

  • SH has also been reported in infants, where they are considered physiologic,4 and in young adults who may have a family history of SH.1

  • SH has been reported overlying other skin lesions including neurofibromas, melanocytic nevi, verruca vulgaris, and skin tags.1

  • Rare forms of SH include giant linear (up to 5 cm in diameter) and functional familial (also called premature or diffuse SH); the latter occur typically around puberty as thick plaque-like lesions with pores resembling an orange peel.1

ETIOLOGY AND PATHOPHYSIOLOGY

  • Sebaceous glands, a component of the pilosebaceous unit, are found throughout the skin, everywhere that hair is found. The greatest number is found on the face, chest, back, and upper outer arms.

  • The glands are composed ...

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