What you should know about sebaceous hyperplasia

Sebaceous hyperplasia appears as small, shiny, spongy bumps on the surface of the skin. Usually they appear on the face, but they could develop anywhere on the body.

The bumps may be a similar color to the surrounding skin, or slightly pink or yellow. They may also have a small indentation in the middle.

The images below show some examples of how sebaceous hyperplasia can present.

The cause of sebaceous hyperplasia is an abundance of sebum-producing cells in the skin. These cells are known as sebocytes, and they are the building blocks of oil glands. When there are too many sebocytes, it leads to a buildup of oil, which then enlarges and blocks the gland.

Oil glands are sensitive to androgens, or male sex hormones. All people have these hormones, to varying extents. In males, these hormones decrease late in life. In females, they begin declining before menopause.

A reduction in androgens reduces the cell turnover, or death, of sebocytes. This leads to their proliferation, and so, more oil production. It is for this reason that sebaceous hyperplasia is more common in older adults.

Other hormones, such as insulin, thyroid stimulating hormone, and cortisol may also play a role in sebaceous hyperplasia. Researchers are also investigating a potential genetic link.

Some medications have associations with the condition, including those that suppress the immune system and antiretroviral drugs for HIV.

Rarely, a genetic condition known as Muir-Torre syndrome causes sebaceous hyperplasia. However, the presence of sebaceous hyperplasia is not a diagnostic measure of Muir-Torre syndrome.

Risk factors for sebaceous hyperplasia

Sebaceous hyperplasia appears to be more likely in:

• older adults
• males
• skin that has UV light exposure
• people undergoing long-term immunosuppression

Sebaceous hyperplasia is harmless in most cases. However, if a person does not like the bumps, they may choose to treat them. This may reduce their appearance.

Some possible treatments for sebaceous hyperplasia include:

Acids

Acids in skin care work by exfoliating away the top layer of skin. They can vary in intensity from daily topical treatments to deep chemical peels a person has occasionally.

A 2019 research paper notes that 70% trichloroacetic acid (TCA) is an effective treatment for sebaceous hyperplasia. People can use it daily for a few months without adverse effects.

However, all exfoliating acids cause sensitivity to UV light, so people need to protect the skin from the sun during use.

Retinoids

Retinoids are a form of vitamin A that may help with a range of skin conditions, including sebaceous hyperplasia.

An older 2015 study suggests that the regular application of retinoids can be an effective treatment for sebaceous hyperplasia. However, the bumps may also return if a person stops using the treatment.

Doctors may also treat sebaceous hyperplasia with oral retinoids, such as isotretinoin. In the same 2015 study, 20 participants with sebaceous hyperplasia who used 1 milligram of isotretinoin per kilogram of body weight per day for a period of 2 months all showed a significant decrease in the number of lesions on their bodies.

Around 2 years after the end of this study, the participants had few recurring lesions, with the average number being only four.

However, other medical literature does not necessarily support this conclusion. Some research indicates that oral isotretinoin treatment may need to be ongoing to maintain results.

If a person stops the treatment, sebaceous hyperplasia may reoccur. Retinoids are also not suitable during pregnancy.

Cryotherapy

A doctor can remove sebaceous hyperplasia bumps in a process known as cryotherapy. The doctor will freeze the bumps, causing them to dry up and drop away.

However, cryotherapy can potentially cause changes in skin color in the affected area.

Laser therapy

Several types of laser therapy may help to treat sebaceous hyperplasia, including:

• carbon dioxide laser
• argon laser
• pulsed dye laser

These treatments are safe, but can sometimes cause temporary side effects such as inflammation or swelling. Not all laser therapies are suitable for darker skin tones, though. People can ask a dermatologist if this is an option for them.

Photodynamic therapy

Photodynamic therapy involves applying a drug to the affected skin. This makes the cells sensitive to light. A health professional then exposes the cells to intense light in order to kill them.

The skin may become extremely sensitive after this treatment, possibly leading to inflammation, irritation, and peeling. Occasionally, photodynamic therapy causes discoloration.

Electrocautery

Electrocautery involves using a charge of electricity to burn the bumps. The skin will then scab over and fall away, leaving behind a smooth area.

Electrocautery may cause skin pigment changes in the affected area and has the potential to leave scars if a person does not perform it correctly.

Surgery

If sebaceous hyperplasia is severe or persistent, a doctor may suggest surgically removing the bumps.

This will prevent them from returning, but it can sometimes cause scarring. For this reason, doctors may consider it as a last resort.

The main symptom of sebaceous hyperplasia is small bumps on the skin. Oil may come out from the indentation in the middle. However, the condition is not the same thing as acne.

Acne forms when hair follicles or pores become blocked with debris and oil. This may cause a visible “head” on the surface of the skin, which may be black or white.

Blackheads are the result of the pore being clogged, and the dirt inside turning black. Whiteheads are the result of bacteria getting inside the pore, resulting in the production of us.

The two conditions may appear similar, but a whitehead or blackhead due to acne will usually have a raised center. They may be slightly painful or inflamed. In contrast, bumps from sebaceous hyperplasia are painless, soft, and spongy.

Sebaceous hyperplasia can also look similar to some types of skin cancer. This is why it is important that people get a diagnosis from a doctor if they have any new or unusual bumps on the skin.

Dermatologists may diagnose sebaceous hyperplasia through a physical examination. They can distinguish sebaceous hyperplasia from other more serious conditions that may bear a resemblance to it, such as basal cell carcinoma.

If a doctor is uncertain about a diagnosis, they may take a sample, or biopsy, and send it to a laboratory for testing.

There is no sure way to prevent sebaceous hyperplasia. Doctors consider exposure to UV light to be a cofactor in the development of the condition, but there is currently no evidence that avoiding UV light reliably prevents sebaceous hyperplasia.

That said, UV light accelerates skin damage and the visible signs of aging in other ways. As such, it is a good idea to protect against it. People can do this by:

• avoiding the sun at the brightest times of the day
• covering the skin with clothing and wearing a hat with a brim
• staying in the shade
• using sunscreen on exposed skin

Sebaceous hyperplasia is a harmless condition that presents as small, soft bumps on the skin. The overgrowth of oil-producing cells inside oil glands in the skin causes it.

Although sebaceous hyperplasia is not harmful, some individuals may wish to reduce the appearance of these bumps or get rid of them completely.

Treatment options include topical TCA acid, retinoids, cryotherapy, laser therapy, photodynamic therapy, and surgical removal.