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

relevant records that met the following criteria were selected for inclusion: case reports, case series, and clinical trials using laser modalities for treatment of sebaceous hyperplasia. Exclusion criteria included non-English articles and review articles. Additional sources from the original source bibliographies were used to further supplement this review. The search yielded a total of 119 results: 41 from PubMed, 16 from EMBASE, 62 from Web of Science. 24 were duplicates, 73 had no information relevant to laser treatment of sebaceous hyperplasia, and 4 were non-English articles, and 8 were excluded due to incompatible article type, and 2 were unattainable due to resource limitations. Of the remaining 8, 1 was a randomized controlled trial (RCT), 1 was an observational study, 3 were case series, and 3 were case reports.

RESULTS

Results of all studies are summarized in Table 1.

Randomized Control Trials
Wang et al report a prospective split-face randomized trial comparing long pulse PDL (LPDL) and short pulse PDL (SPDL) in the treatment of sebaceous hyperplasia.9 They identified 8 patients with a total of 75 sebaceous hyperplasia lesions. 42 lesions were randomized to receive SPDL, and the remaining 33 lesions received LPDL.

LPDL consisted of two sessions of 595-nm LPDL with 20-milisecond pulse duration, 5-mm spot size, 3-5 stacking pulses and 13-21 J/cm2 fluence. SPDL consisted of two sessions of 595- nm SPDL with 0.45-millisecond (ms) pulse duration, 5-mm spot size, 3-5 stacking pulses, and 9-11 J/cm2 fluence. Response rates were categorized into complete reduction, partial reduction and non-reduction. SPDL showed faster treatment response rate than LPDL. Although all SH lesions responded to two sessions of SPDL or LPDL treatments at 8 weeks after the second session, complete reduction was noted in 20 of 42 lesions (47.6%) treated by SPDL, and in 11 of 33 lesions (33.3%) treated by LPDL. No statistically significant difference in the efficacy in reduction lesion diameter or thickness was noted between SPDL and LPDL. No significant difference was noted between the intensity of pain caused by each therapy. No significant difference was noted in post-treatment purpura resulting from SPDL or LPDL at 8 weeks after the second session.

Non-randomized Interventional Study
Kavoussi et al present a prospective, non-randomized trial on CO2 laser therapy and curettage for the treatment of sebaceous hyperplasia.7 They identified 46 patients over an 18-month period. All patients received CO2 laser therapy based on the thickness of their SH lesion, with 2 to 4 passes of pulsed CO2 laser at 5 to 8 watts and 400 ms pulse duration. The lesions were then removed using a disposable curette. Cosmetic outcomes were fair, moderate, and poor in 35 (76.1%), nine (19.6%), and two (4.3%) cases, respectively. The mean recovery time was 11.5 days. No recurrence was seen in patients during the 12-month follow-up period.

CASE SERIES

The authors identified three case series and their results are summarized in Table 1.

Kim et al report on a series of four patients with SH treated with 5-aminolevulinic acid and photodynamic therapy (ALAPDT) combined with CO2 laser.10 All patients received CO2 laser ablation in a focused mode at 1.0 W in a series of brief 0.05 second pulses until the papillary dermis was exposed, after which ALA was applied to the lesion only. Additional treatments were applied every four weeks (total number of treatments ranged from one to four), and final evaluation was performed four months after the last PDT. Clinical responses were evaluated by two dermatologists at four weeks after PDT and classified as no response (<30%), mild (30%-60%), moderate (60%-90%), marked improvement (90%) according to the decrease of lesion counts. Three of four patients showed marked improvement, and all tolerated the therapy. During follow-up at four months after the last PDT, none of the lesions recurred.

Aghassi et al describe their cohort of 10 patients with a total of 29 lesions of sebaceous hyperplasia treated with PDL.11 Preoperative photographs were taken with a 35-mm camera, and confocal imaging was also performed on an accessible lesion with a near infrared, reflectance confocal laser scanning microscope. Each patient received treatment with a 585-nm PDL with 3 consecutive 5-mm pulses of 7 or 7.5 J/cm2 to each lesion. Follow up exams were conducted at 2, 4, and 8 weeks after treatment for repeated photography, clinical evaluation of the size and elevation of each treated lesion by at least two observers, and confocal imaging of the lesion previously imaged. At the final eight-week follow-up, disappearance was noted in 8 of 29 (28%) lesions, a decrease in diameter in 19 of 29 (66%), and flattening in 27 of 29 (93%). 28% recrudesced after initial involution, and 7% recurred completely. No scarring or pigmentary side effects were noted. Confocal imaging revealed a prominent “crown” of blood vessels surrounding the sebaceous duct and coagulation of these vessels with pulsed-dye laser treatment. However, despite the clinical responses, the vessels reappeared during follow-up, and no noticeable morphologic changes in the sebaceous duct were noted.

Finally, a study by No et al used the 1450-nm diode laser on their series of 10 patients with over 330 sebaceous hyperplasia lesions.12 All patients received a 1450-nm diode laser delivered with a 4-mm spot size and a fluence of 16 to 17 J/cm2. Cryogen cooling was set at 40 to 50 ms. Most lesions were treated with a single pulse, except for thicker lesions, which were treated