Article - JDDonline - Journal of Drugs in Dermatology

Douglas Winstanley DO, Travis Blalock MD, Nancy Houghton BS, and E. Victor Ross MD

Scripps Clinic Laser and Cosmetic Dermatology, San Diego, CA

Abstract

Background: Sebaceous hyperplasia is a common benign proliferation of sebaceous glands. Multiple treatment methods have been applied in the past, including electrodessication, ablative and visible light lasers, applications of acids, and photodynamic therapy. Often, however, only the superficial component of the lesion is treated, leading to rapid recurrence. It has been shown that human fat has absorption peaks at 1,210 nm and 1,720 nm. We report the first use of a novel 1,720-nm laser in the treatment of sebaceous hyperplasia in human subjects.
Methods: Four patients with sebaceous hyperplasia underwent a test spot treatment followed by 2 full treatment sessions using the 1,720-nm laser. Photos were taken before treatment, at each treatment session, and 3 months following the last treatment. Pretreatment photographs and 3-month follow-up photographs were compared to assess efficacy.
Results: Four weeks after the final treatment, 3 dermatologists blinded to the date of the photographs and uninvolved with the study evaluated the photos and scored them based on a global assessment comprised of: 1) lesion diameter, 2) lesion height, and 3) lesion color. Many of the lesions resolved almost completely after a single treatment, and no additional treatment was required. Overall, there was a reduction in the color, diameter, and height of the lesions. Crusts were noted by all patients and resolved within 10 days.
Conclusion: The use of this novel device that exploits the intrinsic selectivity of 1,720 nm achieved nearly complete clearance of sebaceous hyperplasia lesions without depressions or scarring. Complete heating of the sebaceous gland and sparing of the surrounding skin offered by this device resulted in clinically apparent improvement with a minimum of adverse effects.

J Drugs Dermatol. 2012;11(11):1323-1326.

INTRODUCTION

Sebaceous hyperplasia is a common benign proliferation of sebaceous glands. Lesions are characterized by multiple lobules emptying into a large central duct. They normally present as round, yellow, umbilicated papules.¹ Although a number of treatment techniques have been reported, they seldom provide a complete cure and often lead to recurrence. Acid destruction, ablative lasers, electrodessication and curettage, isotretinoin, cryotherapy with a copper probe or cotton swab, visible light lasers, intense pulsed light, and finally photodynamic therapy using aminolevulinic acid have all been applied to the sebaceous hyperplasia lesions.^1-4 Although individual sebaceous glands range from 200 to 500 µm in diameter, larger sebaceous hyperplasia lesions usually range from 1 to 2 mm in diameter and can extend 2 mm deep in the dermis. The depth of the lesions demands more than a surface therapy if rapid recurrences are to be avoided. On the other hand, too deep a treatment can result in scarring. Most destructive techniques are nonspecific and are associated with potential complications such as atrophic scarring and dyspigmentation. Isotretinoin has been shown to temporarily shrink sebaceous hyperplasia, but the lesions recur with discontinuation of therapy, and there is a risk of hepatotoxicity, agranulocytosis, hypertriglyceridemia, and teratogenic effects.^5,6

Laser treatment of sebaceous hyperplasia has the potential advantage of selectively targeting the sebaceous gland. Thus far,experience with laser treatment of sebaceous hyperplasia has been limited to devices that are commonly used to treat photodamage but are lacking in selective properties that can specifically target sebaceous glands. These lasers include the carbon dioxide (CO₂), erbium-doped yttrium aluminum garnet, and 1,450-nm diode lasers, which target water, and the pulsed dye laser (PDL), which targets hemoglobin. The absorption spectra of human fat have identified 1,210 and 1,720 nm as relative peaks.⁷ It has been shown that at 1,720 nm, the photothermal excitation of fat is twice the background skin.⁸ Therefore, the potential of selectively targeting fatty tissues, such as sebaceous gland hyperplasia, with preservation of the overlying skin is feasible by using the 1,720- nm near-infrared lipid absorption band. To date, a commercially available laser with the wavelength of 1,720 nm does not exist.

In addition to 1,720 nm, other wavelengths that show selective fat absorption include 920 nm and 1,210 nm. Recent work has characterized the selectivity of 1,210 and 1,720 nm for the sebaceous gland.^7,8 The 1,720-nm laser selectively targets sebaceous hyperplasia with minimal damage to surrounding tissues. A simple ex vivo "bacon study" demonstrated selective heating of the fatty tissue with minimal effect on the muscle tissue (Figure 1). However, human studies are lacking. In this report, we present the first clinical application of a novel 1,720-nm laser in the treatment of sebaceous lesions in humans.