What are the causes of sebaceous hyperplasia?

Updated: Oct 05, 2020
  • Author: David T Robles, MD, PhD, FAAD; Chief Editor: William D James, MD  more...
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Facial papular sebaceous hyperplasia is thought to be caused by a decrease in the circulating levels of androgen associated with aging. Ultraviolet radiation is considered only a cofactor, because sebaceous hyperplasia occasionally occurs on areas of the body where sunlight is not a relevant issue, including the buccal mucosa, areolae, and vulva.

A decrease in circulating androgen results in smaller sebocytes with larger nuclei and lower lipid content, which migrate slowly through the sebaceous gland. As migration and disintegration of the sebocytes slows, the gland becomes enlarged, with a widened sebaceous duct and an increased number of basal cells.

Sebaceous hyperplasia has also been linked to long-term immunosuppression in post-transplantation patients taking cyclosporin A. Although the mechanism for this reaction is poorly understood, it is thought to be specific to the lipophilic cyclosporin A, considering that other immunosuppressants have not been strongly associated with an increased prevalence of sebaceous hyperplasia. Occasionally, presentation is delayed for months after completion of cyclosporin therapy. [19] In 2017, a case of eruptive sebaceous hyperplasia was reported in a renal transplant patient treated with the immunosuppressant tacrolimus. [20]

Although more commonly found in the older population, premature or familial cases have been reported in which younger individuals are affected with multiple lesions, suggesting a genetic predisposition. In these cases of premature familial sebaceous hyperplasia, extensive eruptions appear at puberty and tend to progress with age. [16, 17, 18]

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