II. Epidemiology

  1. Onset in middle age
  2. Rarely occurs at Puberty in familial forms
  3. Intraoral Sebaceous Hyperplasia (Fordyce Spots) are seen in 1% of newborns

III. Pathophysiology

  1. Composed of mature Sebaceous Glands with dilated duct

IV. Causes

  1. Most cases idiopathic with aging
  2. Cyclosporine
  3. Hemodialysis

V. Signs

  1. Characteristics
    1. Pale yellow color
    2. Soft, shiny dome-shaped Papules
    3. May be centrally umbilicated
    4. Usually 2-4 mm in size
    5. May appear cauliflower-like with multiple lobules
  2. Distribution
    1. Forehead, Cheeks, Nose
    2. Vulva

VI. Labs

  1. Biopsy only lesions suspicious for Basal Cell Carcinoma

VII. Differential Diagnosis

  1. Basal Cell Carcinoma
    1. Basal cell is typically more red or pink than the yellow Sebaceous Hyperplasia
    2. Surface vessels are haphazardly positioned (under magnification)
      1. Contrast with inter-lobular vessels only in Sebaceous Hyperplasia

VIII. Management

  1. Biopsy if suspect Basal Cell Carcinoma
  2. Cosmetic removal
    1. Shave excision
    2. Electrodesiccation
    3. Cryosurgery
    4. Laser ablation
    5. Topical bichloracetic acid
    6. Avoid curettage due to scarring
    7. Multiple lesions have been treated with Accutane (oral Isotretinoin)

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