Derm Dx: Small papules on the nose and cheek - Clinical Advisor

Derm Dx: Small papules on the nose and cheek

Slideshow

  • Sebaceous Hyperplasia 1_0513 Derm Dx

  • Sebaceous hyperplasia 2_0513 Derm Dx

  • Sebaceous hyperplasia 3_0513 Derm Dx

A 34-year-old male presents to the dermatology clinic for evaluation of lesions on his nose and cheek that have been present for several years. He is concerned because they are increasing in number, and he feels they are unsightly.

The patient’s past medical history is significant for renal transplantation at the age of 14 years for polycystic kidneys. His medications include atorvastatin, cyclosporine, amlodipine, lisinopril and citalopram.

Sebaceous hyperplasia, a common condition that typically occurs in the elderly, is the enlargement of the sebaceous glands -- the oil-producing glands of the skin. The condition is also a common side effect of cyclosporine, affecting approximately 15% of patients...

Submit your diagnosis to see full explanation.

Sebaceous hyperplasia, a common condition that typically occurs in the elderly, is the enlargement of the sebaceous glands — the oil-producing glands of the skin. The condition is also a common side effect of cyclosporine, affecting approximately 15% of patients who take the medicine long term.

Sebaceous hyperplasia presents as small, whitish-yellow papules. The papules are frequently umbilicated with associated telangiectasia. The condition most commonly affects sun-exposed areas of the face, particularly the infraorbital cheek, the forehead and the temple.

When sebaceous hyperplasia occurs in patients taking cyclosporine, the lesions usually develop after years of continuous therapy. In the case presented above, cyclosporine is very likely the cause of the young man’s extensive sebaceous hyperplasia.

Sometimes sebaceous hyperplasia may present in areas where sebaceous glands are not normally found. When found on the breasts these lesions are termed Montogomery tubercles; on the penis, Tyson’s glands; on the lip, Fordyce spots.

A rare, related condition is familial presenile sebaceous hyperplasia. In this condition, sebaceous hyperplasia presents at puberty and becomes more extensive with age. This may be inherited in autosomal dominant fashion.

Trichoepitheliomas are skin colored dermal papules that present on the face. When the lesions occur in multiples, they may be associated with Brooke-Spiegler syndrome. 

A trichoadenoma is a benign tumor derived from the hair follicle. It usually presents as a solitary warty papule on the face or buttock. 

Fibrofolliculomas are small nondescript skin colored papules affecting the face. They are associated with Birt-Hogg-Dubé syndrome.

Treatment of sebaceous hyperplasia is consists of electrosurgery, laser destruction, or superficial shave biopsy. Oral retinoids such as isotretinoin will reduce the lesions.

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.

References

  1. Bolognia J, Jorizzo JL, Rapini RP. “Chapter 111 – Adnexal Neoplasms” Dermatology. St. Louis: Mosby/Elsevier, 2008.
  2. James WD, Berger TD, Elston DM et al. “Chapter 29 – Epidermal Nevi, Neoplasms, and Cysts” Andrews’ Diseases of the Skin: Clinical Dermatology. Philadelphia: Saunders Elsevier, 2006.
Next hm-slideshow in Clinical Quiz