Created: 24/11/2025
Last updated: 12/12/2025
Important: This content is for informational purposes only and is intended for healthcare professionals. It does not replace clinical assessment or medical judgment, does not establish a doctor-patient relationship, and does not constitute a standard of care. Medicine is rapidly evolving: always verify sources and use this information only as additional input for decision-making.
General
Definition and synonyms
Benign and localized proliferation of mature sebaceous glands, which clinically manifests as yellowish or skin-colored papules, umbilicated, on sun-exposed skin (especially face). Farci 2023
Described since the beginning of the 20th century as a benign lesion associated with skin aging; the term “senile sebaceous hyperplasia” became popular in the second half of the 20th century (classic series of geriatric cases).Marks 1969, Czarnecki 1986
Today it is understood as a benign hamartomatous/adnexal lesion rather than a true neoplasm.Iacobelli 2017
Epidemiology
Very common in middle-aged and elderly adults; approximate prevalence in healthy controls 20–25%. Salim 2006, Farci 2023
Neonatal: very common transient forms (facial papules that resolve spontaneously). Farci 2023
Higher frequency in light phototypes and in photoaged skin; slight predominance in men in some series. Farci 2023
Prevalence is clearly increased in kidney transplant recipients and other immunosuppressed individuals (up to ~30% in some series with cyclosporine). Salim 2006, Pang 2005, Levandoski 2017
Códigos
ICD-10: L73.8 (Other disorders of the hair follicles)
ICD-11: ED91.1 (Sebaceous gland hyperplasia)
Diagnostic checklist (quick)
Essential clinic
Adult (or transplanted/immunosuppressed) with one or multiple 2–4 mm, skin-yellow, soft papules.
Located on the face or other classic area (eyelid, areola, external genitalia).
Umbilicature/central depression, occasionally with sebum drainage.
Without spontaneous ulceration or significant pain.
Dermatoscopy (ideal)
White-yellow lobules.
Crown vessels surround the lesion without crossing the center.
Laboratory / histology (only if in doubt)
When BCC or another tumor is suspected, perform the following:
High-quality dermatoscopy and, if available, RCM.
Punch biopsy or deep shave including superficial dermis.
Histology: enlarged sebaceous lobules with mature sebocytes around a dilated infundibular duct, without atypia.
If all items are met → diagnosis of HS is very likely; if there are doubts (atypical solitary lesion, rapid growth, ulceration) → biopsy is mandatory.
Benign process related to:
Skin aging and photoagingUV radiation increases the size of the sebaceous gland; there are murine models that show sebaceous enlargement after chronic UV exposure.Huh 2023, Farci 2023
androgensThe pilosebaceous unit expresses 5-α-reductase and other enzymes that convert weak androgens to dihydrotestosterone, increasing size and sebaceous activity. Farci 2023
Immunosuppression (calcineurins, steroids): cyclosporine/tacrolimus and systemic corticosteroids promote sebaceous hyperplasia, often eruptive and extensive. Pang 2005, Salim 2006, Levandoski 2017, Huh 2023
Genetics: diffuse presenile familial forms have been described; EGFR-RAS-MAPK pathways have been implicated in some cases. Liu 2016, Farci 2023
Other possible cofactors: HIV and antiretroviral therapy, topical or physical medications (308 nm excimer laser). Huh 2023, Farci 2023
There is no evidence of intrinsic malignant potential; the problem is primarily aesthetic and clinically overlapping with basal cell carcinoma (BCC).
Elementary injury
Papule or small nodule, soft, skin-yellowish in color, often with central umbilication. Farci 2023, Lin 2023
Adult >40 years, light phototype, with multiple 2–4 mm, soft, skin-yellowish papules on the forehead and cheeks, each with a central depression, sometimes from where sebum is expressed.Farci 2023, Lin 2023
Key clinical and dermatoscopic findings
Macroscopic clinical:
smooth, shiny surface;
yellowish color or skin;
rarely erythematous;
very few symptoms (occasional mild itching). Farci 2023
Dermatoscopy:
lobed white-yellow nodules;
central umbilication that corresponds to the dilated infundibulum;
“crown vessels”: linear/curved vessels surrounding the lesion and not crossing the center;
Erythematous-yellowish background; there may be fine branching vessels but less thick than in CBC. Lin 2023, Papadimitriou 2023
RCM (reflectance confocal): well-defined refractile lobules around a central duct, an almost pathognomonic correlate in expert hands. Lin 2023
Clinical evolution
Chronic course, very slow; the number of lesions increases progressively.
Individual lesions remain stable in size or grow by millimeters; they do not ulcerate except in the case of trauma.
Neonatal: spontaneous remission within months. Farci 2023
Atypical forms / variants
Eruptive (multiple lesions over weeks/months): typical of patients on cyclosporine, tacrolimus, or systemic steroids; often extensive on face and trunk. Pang 2005, Levandoski 2017, Huh 2023
Giant: solitary nodules ≥1 cm that may mimic adnexal tumors or BCC. Czarnecki 1986, Kato 1992
Diffuse family presenile: multiple papules in young adults with a family history, often responders to isotretinoin.Liu 2016
Nodular basal cell carcinoma (BCC)Pearly lesion, sometimes with ulceration; thick arborizing vessels crossing the lesion, blue-gray areas; no yellowish color or expression of sebum. Papadimitriou 2023, Farci 2023
Sebaceous adenoma / sebaceoma (especially if it's a large solitary one)
Sebaceous nevus (yellowish plaque on scalp or face in children).Iacobelli 2017
Trichoepithelioma/trichoblastoma
Syringoma (small, firmer, periocular papules without a marked yellow color)
Milia, milia cysts
Xanthelasma/flat xanthomas (yellowish periorbital but macular/plaques)
molluscum contagiosum (umbilicated, but pearly and often inflamed)
Histological pattern
Lobular proliferation of mature sebaceous glands around a follicular infundibulum/dilated sebaceous duct, with preserved reticular architecture → is considered a benign adnexal lesion of the “lobular sebaceous hamartoma” type.Farci 2023, Iacobelli 2017
Microscopic description
Normal or slightly atrophic epidermis.
In the superficial dermis:
Enlarged sebaceous lobes, well circumscribed, composed predominantly of mature sebocytes with vacuolated cytoplasm (“soap foam”) and peripheral nuclei;
1–2 layers of peripheral basaloid (germinative) cells without atypia;
central sebaceous duct and dilated follicular infundibulum corresponding to clinical umbilication;
There should be no significant cytological atypia, abnormal mitoses, or vascular/perineural invasion.
Immunohistochemistry and special stains: They are not usually necessary for typical HS, but useful in differential diagnoses with sebaceous tumors/neoplasms:
EMA, CK7, androgen receptor (AR): frequently positive in sebaceous epithelium, but not specific. Farci 2023, Iacobelli 2017
Adipophylline y Oil-Red-O (in frozen sections) they mark lipid vacuoles in sebocytes; useful for confirming sebaceous differentiation in poorly differentiated neoplasms. Farci 2023, Iacobelli 2017
MMR (MLH1, MSH2, MSH6, PMS2): only indicated if Muir-Torre syndrome is suspected (multiple true sebaceous tumors, family history of colorectal cancer), rarely in isolated HS. Papadimitriou 2023, Iacobelli 2017
Molecular studies
They are not usually required. Mutations in the EGFR-RAS-MAPK pathways have been described in some cases, but they are not routinely used in diagnosis. Farci 2023, Iacobelli 2017
Histological sections document the presence of a mature sebaceous lobular proliferation around a dilated central duct
Sebaceous adenoma: larger lobes but with increased basaloid cells (>2 layers), altered architecture and lower proportion of mature sebocytes (<50%).Farci 2023, Iacobelli 2017
Sebaceoma: solid nodules of basaloid cells with islands of mature sebocytes; more nodular and less lobular pattern. Iacobelli 2017
Routine testing is not required. to confirm the diagnosis. Farci 2023
Additional studies depending on the context:
Transplant patient: assess skin cancer screening and review of immunosuppression regimen. Salim 2006
Suspected Muir-Torre syndrome (multiple true sebaceous tumors, not isolated HS): colonoscopy, genetic/oncology studies (outside the standard HS protocol). Papadimitriou 2023
Dermosocopy and, in centers that have it, RCM These are the most valuable office tools for avoiding biopsies. Lin 2023
Biopsy
Recommended biopsy type
In doubtful lesions with BCC or sebaceous tumors:
Punch 3–4 mm or incisional biopsy including epidermis and superficial/mid reticular dermis.
In very superficial facial lesions with a high suspicion of HS, shave Deep may be enough. Farci 2023
Eyelid: the usual choice is partial or complete excision to combine diagnosis and treatment. My 2024
special considerations
Prefer injuries untreated previously with cryotherapy, electrocoagulation or other destructive methods.
Locate the biopsy in a lesion typical (umbilicated, yellow, without scabs).
In patients undergoing treatment with isotretinoin or immunosuppressants, it is not usually necessary to discontinue them only for a small skin biopsy.
Contraindications
The general ones for any skin biopsy (severe coagulation disorders, inability to discontinue anticoagulation in critical areas, etc.).
Fixing and shipping
Sample in 10% formalin for standard histology.
In many patients, it is optional and purely cosmetic. The choice depends on the number of lesions, their location, skin type, comorbidities, and medications.
First line (practical)
General measures
Daily photoprotection and management of photoaging; avoid excessive UV radiation. Huh 2023
Periodic skin review in transplant/immunosuppressed patients (due to concomitant risk of skin cancer). Salim 2006
Local destructive procedures (for few injuries)
Electrodesiccation / surface electrocoagulation: widely used, cheap; risk of scarring dyschromia in high phototypes. Hussein 2021, Farci 2023
Curettage + electrodesiccation o excisional shave: for major or doubtful lesions (allows histological diagnosis).
Cryosurgery (Q-tip cryosurgery, spray): effective, but with a risk of hypopigmentation and scarring, especially on the face and phototypes III–VI. Wheeland 1987, Ataş 2017
Second/third line
Systemic therapy with isotretinoin
Useful in patients with multiple injuries (e.g., familial or cyclosporine-induced diffuse HS), especially when local treatments would be innumerable.
Reported schemes:
0,2–0,5 mg/kg/day for 2–6 months, with significant improvement; relapse is common months–years after discontinuation. Tagliolatto 2015, Liu 2016, Caytemel 2020
Cases in transplant recipients with cyclosporine-induced HS with good response without impairment of graft function. McDonald 2011, Jung 2016
Lasers and light
Systematic reviews and series:
CO₂, Er:YAG, pulsed dye laser (PDL), KTP, Nd:YAG, intense pulsed light (IPL) They have shown high efficacy with good cosmetic results when parameters are properly adjusted.Simmons 2015, Liu 2020
CO₂/Er:YAG allow very precise ablation of the sebaceous lobule; Er:YAG is associated with somewhat faster recovery. Liu 2020
PDL can be useful alone or in combination with ALA in selected HS. Aghassi 2000, Alster 2003
Photodynamic therapy (PDT) with ALA/MAL
Various schemes with 5-ALA 20% o MAL + blue light, red light, PDL or IPL:
Studies and series show partial or complete clearance of many lesions after 1–3 sessions. Gold 2004, Richey 2007, Alster 2003
Useful in patients with multiple facial HS seeking cosmetic treatment with minimal scarring.
Others
Focal trichloroacetic acid, bichloroacetic acid, topical retinoids: limited evidence, more useful as adjuvants. Farci 2023, Hussein 2021
Care and safety
Systemic isotretinoin
Monitor: liver function, lipids, pregnancy (serial tests in women of childbearing age), mood.
Teratogenic (category X), risk of hypertriglyceridemia, hepatitis, significant mucocutaneous dryness. Tagliolatto 2015, Liu 2016
Laser/TFD
Risk of erythema, pain, edema, post-inflammatory hyperpigmentation, especially in high phototypes; choose conservative parameters and good post-procedure photoprotection. Simmons 2015, Liu 2020
Simple destructive procedures
Risk of scarring and dyschromia; avoid treating all lesions in a single extensive session on the face if the patient is severely photodamaged. Hussein 2021
Relevant contraindications
IsotretinoinPregnancy, breastfeeding, severe liver disease, uncontrolled hypertriglyceridemia, recent history of severe depression or suicidal ideation.
Laser/TFD: known photosensitivity, use of non-suspendable photosensitizing drugs, significant keloid scarring in the area.
Solitary, growing lesion with thick telangiectasias or ulceration → always rule out CBC with dermatoscopy and, if in doubt, biopsy. Farci 2023, Papadimitriou 2023
Transplanted with HS + history of NMSC → increased risk of new skin cancers; avoid assuming "it's just HS". Salim 2006
Multiple true sebaceous tumors (adenomas/sebaceomas), not isolated HS, especially extrafacial → consider Muir-Torre, refer for genetic study and cancer screening. Iacobelli 2017, Papadimitriou 2023
Use of isotretinoin → Monitor pregnancy, liver function and lipids; report the high rate of relapse after discontinuation. Tagliolatto 2015
Aggressive facial treatments in high phototypes → risk of hyperpigmentation/hypopigmentation and scarring; better fractional procedures and/or very superficial ablative lasers. Simmons 2015, Liu 2020
Color yellow-ivory + central umbilication + “crown vessels” that do not cross the center in dermatoscopy → strongly suggestive of HS versus CBC. Lin 2023
Expression of sebo When pressure is applied to the center of the lesion, it is typical of HS and not CBC.
HS is usually multiple and symmetric in sun-exposed areas; CBC is usually solitary and asymmetrical.
In RCM, seeing refractile lobules around a central duct is almost specific.Lin 2023
Updated clinical and dermatopathological review of sebaceous hyperplasia: epidemiology, hormonal and UV pathogenesis, clinical presentation, dermatoscopy, histology, and medical and surgical therapeutic options.
Lin EY, Rao L, Wang WJ, Chen YF. Detection of sebaceous gland hyperplasia with dermoscopy and reflectance confocal microscopy. Front Med (Lausanne). 2023;10:1194748.
DOI: 10.3389/fmed.2023.1194748
PMID: 37457586
Study that characterizes dermatoscopic patterns (yellow-white lobules, “crown vessels”) and RCM findings of HS, correlated with histology; provides useful criteria to avoid biopsies.
Iacobelli J, Harvey NT, Wood BA. Sebaceous lesions of the skin. Pathology. 2017;49(7):688-697.
DOI: 10.1016/j.pathol.2017.08.012
PMID: 29078997
Review of all lesions with sebaceous differentiation, with emphasis on histology, immunohistochemistry and Muir-Torre implications; clearly defines criteria to differentiate HS from adenoma, sebaceoma and sebaceous carcinoma.
Papadimitriou I, et al. Sebaceous Neoplasms. Diagnostics (Basel). 2023;13(10):1676.
DOI: 10.3390/diagnostics13101676
PMID: 37238164
Extensive review of benign and malignant sebaceous neoplasms, clinical and dermatoscopic, and their association with Muir-Torre syndrome; includes a specific section on HS and its differentiation from tumors.
Simmons BJ, et al. Light and laser therapies for the treatment of sebaceous gland hyperplasia: a review of the literature. J Eur Acad Dermatol Venereol. 2015;29(11):2080-2087.
DOI: 10.1111/jdv.13066
PMID: 25731611
Focused review of light and laser therapies for HS (PDL, KTP, Nd:YAG, CO₂, Er:YAG, IPL), with critical analysis of clinical results and side effects.
Liu A, Taylor MB, Sotoodian B. Treatment of Sebaceous Hyperplasia by Laser Modalities: A Review of the Literature and Presentation of Our Experience With Er:YAG. J Drugs Dermatol. 2020;19(5):547-552.
DOI:
PMID: 32484621
Review of published series of HS laser treatment and presentation of experience with Er:YAG, showing high efficacy with minimal pigmentary changes when conservative parameters are used.
Gold MH, et al. Treatment of sebaceous gland hyperplasia by photodynamic therapy with 5-aminolevulinic acid and a blue light source or intense pulsed light source. J Drugs Dermatol. 2004;3(6 Suppl):S6-9.
DOI:
PMID: 15624735
Clinical trial demonstrating the effectiveness of ALA-TFD with blue light or IPL to reduce multiple HS lesions with good aesthetic results.
Tagliolatto S, et al. Sebaceous hyperplasia: systemic treatment with isotretinoin. An Bras Dermatol. 2015;90(2):211-215.
DOI: 10.1590/abd1806-4841.20153192
PMID: 25830991
Small clinical trial showing good response of multiple HS to systemic isotretinoin (0,3–0,5 mg/kg/day) with marked reduction in the number and size of lesions.
Liu YC, et al. Presenile diffuse familial sebaceous hyperplasia successfully treated with low-dose isotretinoin: report of two cases and review. J Dermatol. 2016;43(10):1205-1208.
DOI: 10.1111/1346-8138.13416
PMID: 27130181
Two cases of presenile familial diffuse HS treated with low doses of isotretinoin (0,2–0,3 mg/kg/day) with good tolerance and sustained reduction of lesions.
Salim A, et al. Sebaceous hyperplasia and skin cancer in patients undergoing renal transplant. J Am Acad Dermatol. 2006;55(5):878-881.
DOI: 10.1016/j.jaad.2005.09.041
PMID: 17052497
Case-control study demonstrating a higher prevalence of HS in kidney transplant recipients and a strong association between the presence of HS and a history of non-melanoma skin cancer.
Levandoski KA, Girardi NA, Loss MJ. Eruptive sebaceous hyperplasia as a side effect of oral tacrolimus in a renal transplant recipient. Dermatol Online J. 2017;23(5):13030/qt7x0125gz.
DOI:
PMID: 28537866
First described case of eruptive HS in a kidney transplant recipient treated with tacrolimus without prior exposure to cyclosporine; reinforces the role of calcineurin immunosuppressants.
Huh G, et al. An Excimer Laser-Induced Eruptive Sebaceous Hyperplasia. Ann Dermatol. 2023;35(Suppl 2):S268-S271.
DOI: 10.5021/ad.21.020
PMID: 38061719
Case of eruptive facial HS after phototherapy with 308 nm excimer laser for vitiligo; discusses the role of UV as a cofactor in the pathogenesis of HS.
Ma M, et al. Sebaceous hyperplasia of the eyelid: A comprehensive case report and literature review. Heliyon. 2024;10(7):e28511.
DOI: 10.1016/j.heliyon.2024.e28511
PMID: 38586364
Case of palpebral HS mimicking malignant tumor, with a review of the literature on ocular locations and diagnostic/therapeutic recommendations for oculoplastic surgeons.
Malliah R, et al. Sebaceous hyperplasia of the vulva: case report and review of the literature. J Low Genit Tract Dis. 2006;10(1):55-57.
DOI: 10.1097/01.lgt.0000194825.78244.20
PMID: 16378033
Case of vulvar HS with review of vulvar presentations of sebaceous lesions and differential diagnosis with condylomas, intraepithelial neoplasia and other vulvar lesions.
Rekola A, et al. Areolar sebaceous hyperplasia: case report and literature review. Case Rep Plast Surg Hand Surg. 2025;12(1):2487843.
DOI: 10.1080/23320885.2025.2487843
PMID: 40230816
Description of areolar HS in the context of plastic surgery, with review of previous cases and emphasis on differential diagnosis and reconstructive management.
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