Sebaceous Hyperplasia Causes, Symptoms, and Treatments

Sebaceous Hyperplasia
Photo (c) Klaus D. Peter, Wiehl, Germany / Creative Commons

Sebaceous hyperplasia is a very common condition that causes small bumps on the skin. The bumps are most often skin-colored, but can also take on a white to slightly yellow tint. They range in size from 1 or 2 millimeters to several millimeters in size. The surface of the bumps can be smooth, or slightly uneven and coarse.

Sebaceous Hyperplasia: Enlargement of the Sebaceous (or Oil) Glands

We have tiny glands underneath the surface of the skin called sebaceous glands.

These glands are found everywhere, except for the palms of the hands and soles of the feet. Their job is to create sebum, or oil, for the skin to keep it lubricated and healthy.

In sebaceous hyperplasia, there is an overabundance of sebocytes, the special cells that make up the sebaceous glands (hyperplasia means "overformation"). These cells create an enlargement of the sebaceous gland, causing it to grow to several times larger than its normal size. Now, instead of being a tiny gland under the skin's surface, it's large enough to create a bump easily seen on the skin.

Sebaceous hyperplasia can appear as a single bump, or multiple bumps in a cluster or line. It most often develops on the face, especially the forehead, cheeks, and nose, though it happens anywhere there are many sebaceous glands, including the back and chest, shoulders, areola, penis, scrotum, and vulva. However, it is much more rare in these areas.

Sebaceous Hyperplasia Is Often Confused With Acne Breakouts

Sebaceous hyperplasia is often confused with comedonal acne, because the bumps look very similar to non-inflamed acne breakouts.

If you have a bump on your skin, how can you distinguish between sebaceous hyperplasia and common acne blemishes like closed comedones and milia?

The key to identifying sebaceous hyperplasia is the depressed or pitted area in the center of the bump. This is a clue that you're not dealing with an acne breakout. Sometimes you can see tiny blood vessels (called telangiectasia) in the bump as well.

There's no use in squeezing sebaceous hyperplasia; you won't extract anything from the bump because there is no comedonal core. Squeezing will not get rid of them, but can cause them to become inflamed or bleed.

What Causes Sebaceous Hyperplasia?

There are several factors that contribute to sebaceous hyperplasia. The biggest is a decrease in androgen hormones. Androgen hormones play a big role in the inner-workings of our sebaceous glands.

Androgens (specifically testosterone) stimulate the sebaceous glands to create more oil. When there is an increase in androgens, there is also an increase in sebaceous gland activity. During puberty, there is a huge increase in androgens. That's why your skin is typically much more oily during the teen years than it is at other times in your life. It also explains why acne spikes during puberty; there is a similar spike in androgens.

As we age, androgen hormones decrease. This slows down the sebaceous gland activity.

And it's not just oil production. The natural cell turnover rate within the sebaceous glands slows down as well. The cells back up within the gland, causing that overabundance and enlargement of the gland that was mentioned earlier.

There also seems to be a genetic link. If someone in your family has sebaceous hyperplasia, you're more prone to developing it too, because it is hereditary (but not contagious).

The consensus is that sun exposure also plays a role—yet another reason to wear your sunscreen daily and say no to tanning.

Who Can Get Sebaceous Hyperplasia?

Sebaceous hyperplasia is more common as you get older.

Typically, it doesn't appear until middle age or older. Some people get sebaceous hyperplasia at a much earlier age if there is a strong family history of it, though this is more rare.

Sebaceous hyperplasia affects both men and women about equally. It's seen most often in people with light or fair complexions. The condition is also much more common in those taking cyclosporin long-term, such as people who have had a transplant.

Newborns can develop this condition too (often alongside baby acne), because of hormones passed from mother to baby. The blemishes most often appear on the nose, cheeks, upper lip, and forehead. There's no reason to treat this condition in newborns. The bumps recede and disappear on their own, within a few months after delivery, as maternal hormones dissipate.

How Sebaceous Hyperplasia Is Diagnosed

A simple visual inspection by your physician is often all that is needed to diagnose sebaceous hyperplasia, but if there is any question your physician might order a biopsy to rule out skin cancer. It can sometimes be hard to distinguish between sebaceous hyperplasia and the similar-looking (but more serious) condition of basal cell carcinoma.

Sebaceous Hyperplasia Is Harmless

Sebaceous hyperplasia is purely a cosmetic problem. They are benign, not cancerous, and aren't a precursor to skin cancer like other skin lesions such as actinic keratosis. The bumps don't hurt or itch. But they may bleed if you knock them or shave over them.

Sebaceous hyperplasia won't go away on its own. Once the bumps are there, they are generally there to stay. You can choose to treat them, or leave them be. Either way is OK.

Treating Sebaceous Hyperplasia

Because it's cosmetic only, there's really no pressing reason to treat sebaceous hyperplasia. If the bumps are making you feel self-conscious, though, you may choose to have them treated.

Prescription medications like topical retinoids and azelaic acid may help keep new sebaceous hyperplasia blemishes from forming, because they speed up the skin's natural cell turnover rate. They may also make existing bumps appear smaller, although these topical treatments probably won't get rid of them altogether.

A few tweaks to your skin care routine may be in order too. Although over-the-counter exfoliating products won't get rid of these bumps, some may help reduce the likelihood of development. Moisturizing creams and lotions containing retinol are the best option.

Avoid aggressive scrubbing with gritty products, though. This will irritate the bumps, but won't do anything to improve them.

There are several in-office procedures that you can have done to treat sebaceous hyperplasia. These will give you more obvious improvement of the bumps, and they work much more quickly. Procedures include:

There is a risk of scarring and/or skin discoloration with all of these treatments.

In severe cases of sebaceous hyperplasia, your physician may prescribe isotretinoin. Isotretinoin shrinks sebaceous glands, temporarily at least. To keep sebaceous hyperplasia at bay, it often must be used long-term, so this treatment is used only in extreme cases.

It's important to know that no treatments cure sebaceous hyperplasia, they just control the condition. It's likely to come back over time, even after you have it treated.

A Word From Verywell

Whenever you have a bump, lesion, or any other unknown issue on the skin, it's always important to be seen by a physician to get a proper diagnosis. Because sebaceous hyperplasia looks incredibly similar to the much more serious basal cell carcinoma, you should have your bump(s) looked at by a physician to know for certain what you're dealing with.

If it is sebaceous hyperplasia, the good news is that it's completely harmless. Many people with sebaceous hyperplasia choose not to treat it. Rest assured, those bumps are much more obvious to you than they are to anyone else. But if they make you feel self-conscious, you can have them treated. Your doctor will let you know which procedures and/or medications will be best for your particular situation.

Since sun exposure may increase the risk of developing them, make sure you wear sun screen every day. It's a great skin-healthy habit, whether or not you have sebaceous hyperplasia.

Sources:

Higgins JC, Maher MH, Douglas MS. "Diagnosing Benign Skin Tumors." American Family Physician. 2015 Oct; 92(7):601-7.

Robles DT, Mickelson K. "Sebaceous Hyperplasia." Medscape. 23 June 2017. Web.

Yu C, Shahsavari M, Stevens G, Liskanich R, Horowitz D. "Isotretinoin as Monotherapy for Sebaceous Hyperplasia." Journal of Drugs in Dermatology. 2010 Jun. 9(6):699-701.

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