Treatment of Sebaceous Hyperplasia by Laser Modalities: A Review of the Literature and Presentation of Our Experience With Erbium-doped Yttrium Aluminium Garnet (Er:YAG)

May 2020 | Volume 19 | Issue 5 | Features | 547 | Copyright © May 2020

Published online April 17, 2020

Annie Liu , Mark B. Taylor , Bahman Sotoodian

aThe University of Toronto, Division of Dermatology bGateway Aesthetic Institute & Laser Center, Salt Lake City, UT

Abstract
Introduction: Sebaceous hyperplasia (SH) is a common skin presentation in adults. Due to their unwanted yellow papular appearance, patients may desire their removal. Although several treatment modalities have been reported, the full range and efficacy of options are unclear.
Objective: To determine the efficacy of laser modalities in the treatment of SH. The authors will also specifically assess the efficacy, recurrence rate and side effect profile of SH treatment with Er:YAG wavelength using a variable long pulsed (VLP) Er:YAG laser (SP Dynamis Fotona laser, Ljubljana, Slovenia)
Methods & Materials: A comprehensive literature search was performed through PubMed, EMBASE, and Web of Science, using the search terms [(sebaceous hyperplasia)] and [(laser[s], Er:Yag, Er:Glass, Fraxel, CO2, PDL, Pulse dye laser, Diode, Xe-Cl, Excimer, Argon, KTP, Ruby, Alexandrite or Nd:YAG)]. The search yielded a total of 119 results and 8 were identified as relevant to this review
Results: Pulse dye laser (PDL) provides a wide range of treatment results from complete reduction to flattening of the SH without significant adverse events; recurrence rates were unreported. Short PDL showed faster treatment response than long PDL. CO2 laser can produce considerable positive cosmetic outcomes with marked clinical improvement without any recurrence, but significant adverse effects have been reported. The 1450-nm diode laser has been described to produce good (75%) clinical improvement and lesion shrinkage ranging from 50% to greater than 75% without lasting adverse effects. In our clinic, Er:YAG has provided very significant cosmetic outcomes with a low recurrence rate and minimal adverse effects.
Conclusions: Laser modalities can provide satisfactory results for removing SH. It is crucial that the laser is being used by an expert who is familiar with the device as well as understand the laser tissue interaction to minimize patient adverse effects while providing the best cosmetic outcome. In our experience, Er:YAG laser can provide a safe and highly effective solution for SH.

J Drugs Dermatol. 2020;19(5)   doi:10.36849/JDD.2020.3971

INTRODUCTION

Sebaceous Hyperplasia (SH) is a common skin lesion that can develop after age 40, with a prevalence as high as 26% in older adults.1 The classic senile variant presents as skin colored to yellow papules on the face with central umbilication. Other variants of SHs include transient SH in neonates from exposure to maternal hormones, presentation in rows within the juxta clavicular area, appearing in the context of familial disease, or as an adverse effect of cyclosporine.2 Although a majority of SH may not be associated with an underlying disease, such as Muir-Torre syndrome, patients may desire their removal, particularly when there are multiple larger lesions on the face. There have been several described treatments for SH including isotretinoin,3 electrodessication,4 cryotherapy,5 pulsed dye laser,6 CO2 laser,7 and photodynamic therapy.8

With the ongoing rapid advancement of energy-based devices, we explored the current literature on laser modalities to treat SH. To our knowledge, there has been no published literature review focusing on the treatment of SH by laser modalities. Additionally, there has been no published literature on the treatment of SH with the erbium-doped yttrium aluminum garnet (Er:YAG) laser.

OBJECTIVE

The objective of this study was to determine the efficacy of laser modalities in the treatment of SH. In particular, the authors assessed the efficacy, recurrence rate and side effect profiles associated with Er:YAG laser.

METHODS

A comprehensive literature search was performed through PubMed, EMBASE, and Web of Science on April 2, 2019, using the search terms [(sebaceous hyperplasia)] and [(laser[s], Er:Yag, Er:Glass, Fraxel, CO2, PDL, Pulse dye laser, Diode, Xe-Cl, Excimer, Argon, KTP, Ruby, Alexandrite, or Nd:YAG)]. The