From the Guidelines
Sebaceous hyperplasia lesions are indeed seen more frequently in patients on immunosuppressants, particularly those taking ciclosporin, as evidenced by the British Association of Dermatologists guidelines 1. This association is notable due to the common use of immunosuppressants in patients after organ transplantation and those with autoimmune conditions. The development of sebaceous hyperplasia in these patients can be attributed to the effects of immunosuppressants on sebaceous gland proliferation and the alteration of normal cell turnover processes.
Key Points to Consider:
- Sebaceous hyperplasia appears as small, yellowish or flesh-colored papules, typically on the face, resulting from enlarged sebaceous glands.
- The use of ciclosporin has been specifically associated with sebaceous hyperplasia, as well as other cutaneous side-effects such as acne and acne-like eruptions 1.
- While sebaceous hyperplasia is benign and does not require treatment for medical reasons, patients bothered by their appearance can consider several treatment options, including electrodessication, laser therapy, or topical retinoids, under the guidance of a dermatologist.
- It is crucial for patients on long-term immunosuppressive therapy to be monitored for these lesions during regular skin examinations to address any cosmetic or potential health concerns early.
- The treatment of sebaceous hyperplasia with isotretinoin has been reported in cases associated with ciclosporin use 1, highlighting the need for personalized treatment approaches based on the patient's immunosuppressive regimen and skin condition.
From the Research
Sebaceous Hyperplasia and Immunosuppressants
- Sebaceous hyperplasia (SH) is a benign tumor that can be triggered by various factors, including genetic factors, aging, ultraviolet rays, sex hormones, and certain medications such as calcineurin inhibitors (e.g., cyclosporine, tacrolimus) and systemic steroids 2, 3.
- The development of SH has been observed in patients on immunosuppressants, particularly those taking cyclosporine, with a reported frequency of up to 30% in renal transplant patients 4 and around 10% in patients treated with cyclosporine 3.
- The exact cause of SH in immunosuppressive therapy is poorly understood, but it is thought to be related to the stimulatory effect of cyclosporine on undifferentiated sebocytes, leading to an increase in sebaceous gland size and secretion of sebum 2, 4.
- SH can also occur in patients taking other immunosuppressants, such as tacrolimus, mycophenolate mofetil, and prednisone, suggesting a possible complex etiology involving multiple medications and genetic components 5.
Clinical Presentation and Treatment
- SH typically presents as asymptomatic papules on the face, chest, or groin, and can be cosmetically undesirable, leading to significant negative psychological impact 6.
- Various treatment modalities have been described, including oral isotretinoin, cryotherapy, surgery, electrodessication, lasers, and topical photodynamic therapy (PDT), with effectiveness depending on factors such as the number of lesions, financial cost, psychological factors, skin phototype, and age 6.
- Customizing the treatment modality according to individual parameters can lead to effective clearance of SH lesions with a good cosmetic outcome 6.