Treatment of Sebaceous Hyperplasia With a Novel 1,720-nm Laser

November 2012 | Volume 11 | Issue 11 | Original Article | 1323 | Copyright © November 2012

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


Four patients were recruited into this institutional review board-approved study. All patients presented with at least twenty 0.5- to 1.5-mm umbilicated yellow papules consistent with sebaceous hyperplasia. The laser was a 1,720-nm laser (Del Mar Medical Technologies, Del Mar, CA) delivering up to 5 W through a 400-µm fiber (0.22 numerical aperture). Power was measured through a built-in power meter. Test spots were performed after photographs were taken with a Nikon digital SLR camera (Model D90; Melville, NY) equipped with a Canfield twin flash (Canfield Imaging Systems, Fairfield, NJ) with and without polarization. The power to tissue was up to 4 W. Dwell times ranged from 30 to 200 ms, The spot size was 500 to 750 µm, and average dwell time (on time) of 50 ms resulted in a fluence of about 45 J/cm2. The desired end point was a change from a pretreatment granular yellow appearance to a creamy, white, smooth surface (Figure 2). In some cases, the individual lobules were observed to extrude from the surface. A pinpoint pirouetting technique was applied to treat larger lesions, where individual lobules were heated with the fiber tip held about 1 to 2 mm off the skin's surface. For smaller lesions, the entire lesion was treated with one pulse. Settings ranged from 3 to 3.8 W, and pulse durations in continuous wave mode from 50 to 200 ms. Representative settings are described in Table 1. After the test spots were performed, patients returned in 3 weeks for evaluation. The treating physician determined the best settings by noting the parameters that achieved the greatest reduction in lesion size with the lowest number of side effects. Two treatment sessions were carried out at 3- to 4-week intervals, and the final follow-up was 12 weeks after the final treatment. Test spots showed that the optimal setting combination was 4 W (maximum power to tissue) and 50 ms. The spot size at the skin's surface was estimated to be 0.075 to 1 mm. The resulting calculated fluence was about 45 J/cm2. Smaller dwell times resulted in inadequate heating (lack of clear coagulation response), and longer dwell times and lower powers resulted in poorer heat confinement (coagulation that extended beyond the lesion perimeter). Damage to adjacent normal skin showed no change until the dwell time exceeded 2 times that of the sebaceous hyperplasia. One 2-mm punch biopsy was obtained just after treatment in 1 patient.
table 1
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. Diameter was measured by using the background identification tape that was scored in mm. Height was measured by scoring a lesion as flat or raised. The color was either yellow or flesh color. The grading system used the following scale to assess global improvement: 0 = no improvement, 1 = 1% to 25% improvement, 2 = 26% to 50% improvement, 3 = 51% to 75% improvement, 4 = 76% to 99% improvement, and 5 = complete removal.


All patients completed the study. The mean transmitted power and dwell times were 3.5 W and 50 ms. Immediate responses with increasing dwell times from 20 to 200 ms over the same power density ranged from no response to coagulation that