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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 106-107

Sebaceous hyperplasia: Treatment with combination of oral isotretinoin and salicylic acid chemical peeling


Department of Dermatology and STDs, Dr. Ram Manohar Lohia Hospital and PGIMER, New Delhi, India

Date of Web Publication20-Dec-2016

Correspondence Address:
Sushil Kakkar
Department of Dermatology and STDs, Dr. Ram Manohar Lohia Hospital and PGIMER, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-3972.196174

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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

Sir,

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. [1] 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. [2],[3],[4],[5],[6],[7],[8] Traditionally, isotretinoin has been used in a standard dose of 1 mg/kg/day for 2-3 months in sebaceous gland hyperplasia; [6],[7],[8] 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. [9]

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bader RS, Scarborough DA. Surgical pearl: Intralesional electrodesiccation of sebaceous hyperplasia. J Am Acad Dermatol 2000;42:127-8.  Back to cited text no. 1
    
2.
Simmons BJ, Griffith RD, Falto-Aizpurua LA, Bray FN, Nouri K; International League of Dermatological Societies; European Dermatology Forum. Light and laser therapies for the treatment of sebaceous gland hyperplasia a review of the literature. J Eur Acad Dermatol Venereol 2015;29:2080-7.  Back to cited text no. 2
    
3.
McDonald SK, Goh MS, Chong AH. Successful treatment of cyclosporine-induced sebaceous hyperplasia with oral isotretinoin in two renal transplant recipients. Australas J Dermatol 2011;52:227-30.  Back to cited text no. 3
    
4.
Grekin RC, Ellis CN. Isotretinoin for the treatment of sebaceous hyperplasia. Cutis 1984;34:90-2.  Back to cited text no. 4
    
5.
Burton CS, Sawchuk WS. Premature sebaceous gland hyperplasia: Successful treatment with isotretinoin. J Am Acad Dermatol 1985;12:182-4.  Back to cited text no. 5
    
6.
Tagliolatto S, Santos Neto Ode O, Alchorne MM, Enokihara MY. Sebaceous hyperplasia: Systemic treatment with isotretinoin. An Bras Dermatol 2015;90:211-5.  Back to cited text no. 6
    
7.
Wang W, Qiu Y, Zhou G, Pei Z, Zhang F. Premature sebaceous hyperplasia with satisfactory response to oral isotretinoin. Indian J Dermatol Venereol Leprol 2016;82:113.  Back to cited text no. 7
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8.
Yu C, Shahsavari M, Stevens G, Liskanich R, Horowitz D. Isotretinoin as monotherapy for sebaceous hyperplasia. J Drugs Dermatol 2010;9:699-701.  Back to cited text no. 8
    
9.
Sgontzou T, Armyra K, Kouris A, Bokotas C, Kontochristopoulos G. Repeated salicylic acid peels for the treatment of hyperplastic sebaceous glands in hypohidrotic ectodermal dysplasia. J Cosmet Laser Ther 2014;16:293-5.  Back to cited text no. 9
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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