Perceptions, Utilization, and Cost Assessment of Sebaceous Hyperplasia Treatment Modalities: A Pilot Survey

February 2024 | Volume 23 | Issue 2 | 29 | Copyright © February 2024


Published online January 29, 2024

doi:10.36849/JDD.7734

SH Millan MDa, GE Sellyn MAb, Adam J Friedman MD FAADa

aDepartment of Dermatology, The George Washington University Hospital, Washington, DC
bVanderbilt University School of Medicine, Nashville, TN

Abstract
Background: Sebaceous hyperplasia (SH) is a common, benign but cosmetically bothersome skin condition preferentially affecting older adults. Despite multiple treatment options, there is no universally accepted first-line treatment for SH nor standard pricing for said approaches. 
Methods: A survey aimed at evaluating treatment approaches and their respective costs was disseminated on the Orlando Dermatology Aesthetic and Clinical Conference email listserv. 
Results: Out of 224 dermatologists who participated in the survey (response rate 9.2%), most treated patients with SH (95.98%). In-office procedures were used more than pharmacologic treatments (P=<0.05). Treatments most used by respondents included electrodesiccation (ED; 83.9%), cryosurgery (35.3%), oral isotretinoin (32.6%), and carbon dioxide (CO2) laser (19.2%). Cryosurgery and ED priced between <$200 to $400. Most reported 1 to 2 sessions to achieve lesion clearance for ED, CO2 laser, and cryosurgery. Twenty-one percent reported 3-4 sessions with cryosurgery. Chemical peels, diode lasers, and photodynamic therapy required between 2-4 sessions. Respondents indicated lesions were most unlikely to recur with ED and CO2 laser. Most dermatologists (86.39%) agreed or strongly agreed that they were exposed to new treatment methods for SH through this survey and 86.49% of dermatologists were interested in learning about treatments employed by others.
Conclusion: SH is a common issue that presents in the dermatologist's office. These data highlight the perception that ED is the most common approach employed, associated with lower costs, and requiring fewer sessions to achieve resolution. More data is needed and wanted to better determine best practices for the management of SH.

J Drugs Dermatol. 2024;23(2):29-37.  doi:10.36849/JDD.7734

INTRODUCTION

A recent literature review suggested that the ef fectiveness of sebaceous hyperplasia (SH) treatment was attributed to lesion severity, patient-specific qualities, and cost, rather than a specific treatment modality.1 Ambiguity surrounding the effectiveness of SH treatments stems from the limited comparative potential of studies in the current literature due to varying primary outcomes, study designs, parameters for determining lesion improvement, and literature reviews focusing on a sole treatment method.1 This study investigates the variability of SH treatment approaches among dermatologists and aims to identify the most cost-effective, first-line treatment option.

MATERIALS AND METHODS

An IRB-approved (protocol NCR213612) 19-question survey was designed using the online platform, SurveyMonkey, and sent via a single email to dermatologists on the Orlando Dermatology Aesthetic and Clinical Conference listserv in August 2021. The email included a brief description of the study's objectives, the voluntary nature of the survey, and a direct link to the questionnaire. 

The mean total cost of procedural-based treatments for SH was estimated using survey responses, which included procedure-specific cost per session and the average number of sessions to achieve lesion clearance. Weighted averages were used to compare values. Number of sessions rather than the duration of treatment was investigated given that there is greater interval variability between treatment sessions. 

The mean total cost of pharmacologic-based therapy for SH took into account medication dosage, administration frequency, and treatment duration provided by participating dermatologists in combination with the average daily medication price. The cost of each specific pharmacologic agent was obtained from Medi-Span Price Rx using UpToDate. All costs are presented in United States dollars. 

RESULTS

The demographics and clinical practice descriptions of respondents are detailed in Table 1. The majority of respondents were female (59.4%) and worked in a private practice (69.6%), with 24% of participants practicing outside of the United States. 
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