|LETTER TO EDITOR
|Year : 2016 | Volume
| Issue : 2 | Page : 106-107
Sebaceous hyperplasia: Treatment with combination of oral isotretinoin and salicylic acid chemical peeling
Sushil Kakkar, Prafulla K Sharma
Department of Dermatology and STDs, Dr. Ram Manohar Lohia Hospital and PGIMER, New Delhi, India
|Date of Web Publication||20-Dec-2016|
Department of Dermatology and STDs, Dr. Ram Manohar Lohia Hospital and PGIMER, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kakkar S, Sharma PK. Sebaceous hyperplasia: Treatment with combination of oral isotretinoin and salicylic acid chemical peeling. Indian J Drugs Dermatol 2016;2:106-7
|How to cite this URL:|
Kakkar S, Sharma PK. Sebaceous hyperplasia: Treatment with combination of oral isotretinoin and salicylic acid chemical peeling. Indian J Drugs Dermatol [serial online] 2016 [cited 2019 Mar 26];2:106-7. Available from: http://www.ijdd.in/text.asp?2016/2/2/106/196174
A 45-year-old Indian male presented with multiple raised skin lesions on his face since past 5-6 years. Lesions were asymptomatic, without any seasonal variation and had progressively increased in number. The patient was in good health and had no other symptoms. Family history was not significant. On cutaneous examination, his facial skin was greasy and he had numerous, skin-colored, firm, umbilicated papules on the face, measuring 2-5 mm, distributed mainly in the centrofacial region, i.e., nose, nasolabial folds, and perinasal area, but a few other lesions were also present on the cheeks and forehead [Figure 1]a and [Figure 2]a. Rest of the cutaneous examination was normal. A skin biopsy from one of the papules showed an intact epidermis, normal lobules of mature sebaceous glands and gland duct in the dermis [Figure 3]. These findings were consistent with a diagnosis of sebaceous hyperplasia. We planned to start the patient on oral isotretinoin, in a dose of 0.5 mg/kg along with sessions of 30% salicylic acid chemical peeling, once every two weeks; the patient was followed every two weeks. This treatment plan resulted in complete clearing of lesions within 6 weeks [Figure 1]b and [Figure 2]b, with a total cumulative dose of 21mg/kg of isotretinoin. At this point of clinical cure, isotretinoin was discontinued and we were able to maintain the patient on just monthly salicylic acid chemical peels. The patient showed no sign of recurrence of SGH at 6 months follow up.
|Figure 1: (a) Patient at presentation and (b) patient after 6 weeks of oral isotretinoin (0.5mg/kg/day) and bimonthly salicylic peels|
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|Figure 2: (a) Patient before treatment and (b) patient after 6 weeks treatment with isotretinoin and salicylic acid peeling session|
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|Figure 3: Skin biopsy from umbilicated papules showing mature sebaceous lobules, gland duct, and normal overlying epidermis|
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Sebaceous gland hyperplasia is a benign condition and presents primarily on the face as asymptomatic, skin-colored or yellowish, umbilicated papules. Traditional methods of treatment such as cryosurgery, electrodesiccation, curettage, shave excision, and topical trichloroacetic acid/bichloroacetic acid involve destruction of entire gland but can lead to sequelae such as scarring and discoloration. Therefore, depending on the number of lesions and the cosmetic concerns of the patient, it may be necessary to avoid such interventions.  Isotretinoin is a known inhibitor of the size and function of sebaceous glands, and on literature, review isotretinoin has been found to be an effective option producing either complete or substantial clearing of sebaceous hyperplasia, without incurring any risk of scarring and discoloration. ,,,,,, Traditionally, isotretinoin has been used in a standard dose of 1 mg/kg/day for 2-3 months in sebaceous gland hyperplasia; ,, however, at this dosage, it is usually associated with troublesome mucocutaneous side effects leading to discontinuation of treatment in some patients. In our patient, isotretinoin was given at a lower dose of 0.5 mg/kg/day for 6 weeks, reaching a total cumulative dose of 21 mg/kg, which was very well tolerated. There has been only one case published in English literature regarding the use of salicylic acid peel in sebaceous hyperplasia in a patient with ectodermal dysplasia. 
We assume that using isotretinoin and salicylic acid chemical peeling together results in faster and complete resolution of lesions of sebaceous hyperplasia as well as minimizes mucocutaneous side effects of isotretinoin due to its shortened treatment course while being able to maintain the improvement with salicylic acid peeling alone. In addition, this combination approach has other advantages in that it offsets any risk of scarring and discoloration due to procedures (e.g., electrocautery, cryosurgery, and trichloroacetic acid application) in patients who have numerous lesions of sebaceous hyperplasia, particularly at cosmetic sensitive sites such as face; as well as an option in those who are not able to afford or have access to treatments such as lasers and photodynamic therapy.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]