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Background: Sebaceous gland hyperplasia (SGH) is a benign cutaneous proliferation of the sebaceous glands that primarily affects the elderly group and frequently appears in individuals receiving long-term ciclosporin therapy such as organ transplant recipients. In the latter group, SGHs are usually multiple in number and occur predominantly on the face. Patients may find their appearance cosmetically undesirable and, in some cases, may result in significant negative psychological impact. There is, therefore, a demand for safe and effective treatment for SGH particularly in this patient group. A variety of treatment modalities have been previously described including electrodessication,surgery, cryotherapy, oral isotretinoin, lasers, and topical photodynamic therapy (PDT)., Methods: The objective of this paper is to review the various treatment modalities for SGH. We performed a systematic literature review using the National Library of Medicine's PubMed Database, whereby we included articles that met the following criteria: published in English, not focused on SGH in rhinophyma, studies with adult sample with SGH lesions, and studies with patients with SGH related to ciclosporin., Results: Our findings show that the literature is categorized according to the treatment modalities ranging from conventional techniques such as oral isotretinoin and cryotherapy to more advanced topical PDT, lasers and a combination of both. We found that effectiveness does not depend on the technique itself but instead on the number of lesions, financial cost, psychological factors, skin phototype and age., Conclusions: Our work shows that SGH can be treated effectively by customizing the treatment modality according to different parameters, while effectively maintaining clearance of SGH lesions with best cosmetic outcome.

Skin is the largest peripheral endocrine organ and functions as a hormone target and endocrine gland. A cutaneous hypothalamus-pituitary-adrenal (HPA)-like axis enables the skin to respond to stress and regulates its steroidogenic activity. The pilosebaceous unit is a site for production and metabolism of a number of steroid hormones, including stress and sex hormones. This is an overview of the important role that the cutaneous HPA-like-axis plays in the pathogenesis and treatment of inflammatory pilosebaceous disorders, including acne, rosacea, seborrheic dermatitis, and hidradenitis suppurativa.

Sebaceous glands without a follicular structure are present in the eyelid margin (meibomian glands), lip, glans penis and vulva. Inflammatory disease of a sebaceous gland lacking follicles is rare, except for meibomitis. We report the first two cases of vulval sebaceous adenitis. Painful, yellowish-orange papules/nodules recurred at the vulval mucocutaneous junction or mucosa during the luteal phase of the menstrual cycle. Histopathologically, a dense neutrophilic infiltration was observed within the sebaceous ducts. In both cases, oral minocycline improved the condition. They had been treated with antiherpetic agents. It is possible that women diagnosed with recurrent genital herpes have genital neutrophilic sebaceous adenitis., (© 2016 Japanese Dermatological Association.)

The study aimed to verify the therapeutic action of isotretinoin in the treatment of sebaceous hyperplasia. During two months, 20 patients with sebaceous hyperplasia took isotretinoin at a dosage of 1mg/kg per day. Their skin lesions were counted and photographed before and after treatment and re-evaluated two years later. The average number of sebaceous hyperplasia lesions before treatment was 24 per patient. At the end of two months of therapy, the number of lesions decreased to 2 per patient. The statistically analyzed data showed a reduction in the number of lesions following isotretinoin use (p < 0.05). Two years after the end of the treatment, the average number of sebaceous hyperplasia lesions was 4 per patient. There were no severe side effects. Thus, the data analysis suggests that isotretinoin is a safe and effective drug for treating the disease under study.

Sebaceous adenitis, an idiopathic inflammation of the sebaceous gland, is a condition that is well described in animals but has been reported only thrice previously in humans. We present a series of 11 cases of sebaceous adenitis that presented as tender nodular lesions clinically similar to hidradenitis suppurativa, but was confined to the labia minora. All cases responded to tetracyclines and anti-androgen therapy., (© 2013 The Authors. Australasian Journal of Dermatology © 2013 The Australasian College of Dermatologists.)

Background: Neutrophilic sebaceous adenitis is a very rare disease with only three reported cases, all involving men. Herein, we describe the first case in a woman., Materials and Methods: A 25-year-old woman presented erythematous and indurated circinate plaques on the face, upper chest and upper limbs, associated with some pustules. The eruption started immediately after sunny holidays and extended progressively with low-grade fever and axillar polyadenopathies. Blood tests showed moderately elevated neutrophils and elevated erythrocyte sedimentation rate. Cutaneous biopsy showed an inflammatory infiltrate composed of lymphocytes, histiocytes and neutrophils with perisebaceous distribution, infiltrating sebaceous glands with focal necrosis of sebocytes. Treatment consisting of topical steroid and photoprotection quickly resulted in regression of the lesions, with no relapse after two months., Discussion: Classically neutrophilic sebaceous adenitis presents as erythematous and violaceous, indurated, circinate plaques with raised edges on the face and upper chest. Spontaneous regression is frequently reported. Histological examination is typical with an inflammatory infiltrate containing neutrophils with primarily perisebaceous distribution and penetrating sebaceous glands in places with necrosis of sebocytes. The aetiology is unknown but in a recent case, photodermatosis was suspected because lesions occurred every summer. This hypothesis is consistent with our observation but the presence of lesions on non-exposed areas raises questions about heat as a possible trigger factor in this disorder., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Sebaceous adenitis is an inflammatory skin disease of unknown etiology that leads to a poor haircoat. It occurs mostly in young adult to middle-aged dogs. Clinical signs vary in severity and distribution among breeds and types of haircoat. Lesions include alopecia, scaling, and follicular casts that are typically distributed over the face, head, pinnae, and trunk. Diagnosis is based on histopathologic findings of sebaceous gland inflammation and loss. Treatment for sebaceous adenitis involves lifelong management with various topical therapies containing keratolytic/keratoplastic agents, emollients, and humectants in addition to oral therapies such as omega-3/omega-6 fatty acids, cyclosporine, and/or retinoids.

The human sebaceous gland is a microscopic branched type multiacinar gland been present everywhere on the body except on the palms and soles, whereas they are sparsely located on the dorsum of hands and feet. Several medical conditions are related with sebaceous gland pathology, such as acne, sebaceous hyperplasia, sebaceous adenoma and sebaceous carcinoma. Acne is a common, complex, chronic disorder of the human pilosebaceous unit that mostly occurs in adolescence and young adulthood. The sebaceous gland plays an exquisite role in the initiation of the disease. The multifactorial nature of the pathogenesis of acne includes increased sebum production, alteration of the quality of sebum lipids, inflammatory processes, interaction with neuropeptides and dysregulation of the hormone microenvironment, follicular hyperkeratinization and inflammation maintained by Propionbacterium acnes products within the follicle. On the other hand, the sebaceous gland, as a major and critical compartment of human skin, is also affected through ageing, both intrinsic and extrinsic, which lead to distinct clinical and histological changes. Intrinsic ageing of the sebaceous gland is determined primarily by genetic factors and hormonal status, with androgens playing a major role. A clinical manifestation associated with intrinsic ageing changes is skin xerosis. Extrinsic ageing of human sebaceous gland is mainly caused by accumulating UV irradiation, especially UVA. Photoageing of sebaceous gland is expressed with a wide spectrum of benign and malignant sebaceous tumours, such as sebaceous hyperplasia, sebaceous carcinoma and Muir-Torre syndrome. This review will focus on the pathogenesis of the most common sebaceous gland diseases and their molecular pathways which may represent future pharmaceutical targets.

Medical records of dogs with sebaceous adenitis diagnosed by histopathology over an 18-year period were reviewed. From a total of 40 cases, 24 were treated with oral vitamin A. Dogs ranged from 9 months to 12 years of age at the time of disease onset. Purebred as well as mixed-breed dogs were affected. Akitas represented approximately one-third of the affected population. No sex predilections were observed. Vitamin A was administered for a minimum of 1 month. Doses varied from 380 to 2667 IU/kg/day, with a mean of 1037 IU/kg/day. Two dogs received oral vitamin A exclusively. Concurrent treatments included systemic antibiotics, systemic antifungal medications, fatty acid supplementation and various topical treatments. Of 24 dogs treated with vitamin A, three were lost to follow-up. Twelve owners were satisfied with the overall appearance of their dogs, reporting ≥25% improvement in clinical signs, including level of pruritus, amount of scale, alopecia and overall coat quality, compared with pretreatment appearance. Three owners observed adequate initial improvement, with regression to pretreatment state within 6 months of starting treatment. Two owners reported 25-50% improvement in clinical signs while on oral vitamin A supplementation; however, changes were attributed to concurrent topical treatment. Six owners reported no improvement and discontinued oral administration of vitamin A within 7 months. No correlations could be made between vitamin A dosage and response to treatment; prognoses could not be made based on clinical and histopathological findings., (© 2011 The Authors. Veterinary Dermatology. © 2011 ESVD and ACVD.)

Sebaceous adenitis is a suspected immune-mediated disease that targets and destroys sebaceous glands. This retrospective study evaluated the clinical presentation and incidence of sebaceous adenitis in Havanese dogs. Sebaceous adenitis was diagnosed in 35% (12 of 34) of Havanese dogs presented over a 5-year period. Onset of clinical signs occurred during young adulthood. Follicular casts were present in 92% (11 of 12) of affected dogs. Other common clinical signs included alopecia and hypotrichosis. The trunk, head and ears were commonly affected, with 67% (8 of 12) of cases having pinnal and/or external ear canal involvement. Secondary pyoderma was seen in 42% (5 of 12) of dogs. Histopathology revealed absent sebaceous glands in 83% (10 of 12) and a lymphoplasmacytic periadnexal infiltrate in 92% (11 of 12) of samples. Treatment included multiple modalities. Cyclosporin was prescribed in 83% (10 of 12) of cases. Other systemic therapies included vitamin A and fatty acid supplementation. Topical therapies included antiseborrhoeic shampoos and sprays, and oil soaks. Follow-up ranging from 2 months to 3 years was obtained in 67% (8 of 12) of dogs. Improvement ranged from minimal to marked, with better clinical response associated with longer duration of treatment. Owners with follow-up of more than 1 year commonly reported occasional flares of the clinical signs. This study found that sebaceous adenitis was a common diagnosis in Havanese dogs, that the ears were commonly affected and that a lymphoplasmacytic periadnexal infiltrate associated with absent sebaceous glands was frequently seen on dermatohistopathological examination., (© 2010 Dermatology for Animals/Veterinary Dermatology. © 2010 ESVD and ACVD.)

Canine idiopathic sebaceous adenitis (ISA) is an inflammatory reaction of sebaceous glands, potentially resulting in their complete loss. It is considered a T-cell-mediated disease, but its precise pathogenesis is still unknown. Topical treatment with oil soaks, humectants and shampoos is effective but laborious. Ciclosporin A (CsA), an immunomodulatory drug, has recently been shown to ameliorate the clinical picture of ISA and to reduce inflammation greatly. It is, however, an expensive treatment option. The objective of this multicentre, partly double-blinded, randomized controlled study was to evaluate the efficacy of ciclosporin A, either alone or with topical therapy, in comparison to conventional topical treatment alone, as measured by the primary end-points alopecia and scaling, and multiple histopathological secondary objectives. Thirty-four dogs with an established diagnosis were treated for 4-6 months and were evaluated before, during and after therapy. Both CsA and topical therapy demonstrated efficacy in this study. Differences between the treatment protocols were marginal. Topical treatment, both alone and in combination with CsA, appeared to reduce scaling more effectively than CsA alone. Both therapies reduced alopecia. There is evidence of a synergistic benefit on both scaling and alopecia, if both treatment options are combined. Inflammation of the sebaceous glands is also best reduced by a combination of both CsA and topical therapy. There is evidence that regeneration of sebaceous glands is best achieved by CsA, either given alone or in combination with topical treatment., (© 2010 The Authors. Journal compilation © 2010 ESVD and ACVD.)

Purpose: This prospective observational noninterventional study aimed at collecting information on changes in cycle control, dysmenorrhea, androgen-related skin conditions and tolerability in a large cohort of women who switched their oral contraceptive (OC) to 2.0 mg chlormadinone acetate (CMA)/0.03 mg ethinylestradiol (EE) (Belara)., Materials and Methods: In a total of 20,897 women who were enrolled in a four-cycle clinical evaluation at 1597 gynecological practices throughout Germany, there are 16,781 women who switched from another contraceptive., Results: The most frequently mentioned complaint for switching contraceptive was seborrhea/acne (6933/16,781 women; 41.3%). This was followed by cycle irregularities (18.8%), headache (15.9%), breast tension (15.1%), amenorrhea (14.9%), spotting (12.8%) and dysmenorrhea (11.7%). After switching to CMA/EE treatment, these symptoms decreased substantially or even disappeared in a large number of women. The vast majority of study participants scored both tolerability and well-being on CMA/EE intake as 'very good' or 'good'. The results revealed that 13,508 women (80.5%) stated being more satisfied or even much more satisfied on CMA/EE intake compared to their previously used contraceptive; most of them had taken progestins of the nortestosterone type. CMA/EE produced beneficial effects on skin conditions and well-being in OC switchers who experienced dissatisfaction with their previous contraceptive regimen., Conclusion: The results of this observational study support that 2.0 mg CMA/0.03 mg EE is well tolerated, provides a reliable cycle stability and is very effective in diminishing dysmenorrhea and other cycle-related complaints. Women suffering from problems on hormonal contraception received benefit from switching to the progesterone derivative CMA-containing OC.

Acne vulgaris is a common skin condition seen by physicians. It primarily affects adolescents, but can continue into adulthood. A key factor in the pathogenesis of acne is sebum production. Typical therapy includes combinations of topical retinoids and antimicrobials for mild acne, with the addition of oral antibiotics for moderate to severe disease. In the most recalcitrant cases or for nodulocystic acne, oral retinoids are indicated. In women who fail to respond to conventional treatment, hormonal therapy is often used adjunctively. Only isotretinoin and hormonal therapy improve acne via their action on the sebaceous glands. This article focuses on the mechanisms by which these treatment modalities act on the sebaceous glands and their clinical use in the practice of medicine.

Current therapies for sebaceous hyperplasia (SH) have a high risk for adverse effects and recurrence of treated lesions. The theoretic basis for the treatment of SH by photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) has been established. Studies show that 1 hour is sufficient ALA incubation time to achieve clearance, and ALA-induced protoporphyrin IX may be activated with a 585-nm pulsed dye laser device, blue light source, or an intense pulsed light device. Complete clearance may be achieved with one to six treatments; however, long-term recurrence rates are not established. ALA PDT is a safe and effective modality for the treatment of SH lesions of all sizes.

We report a case of a 19 month old boy that presented with acneform eruption on his cheeks since birth. This condition was left untreated until the age of one. At that time the lesions developed into inflammatory nodules that resolved after topical treatment (Aknemycin fluid, cynober-sulfer pastae) and remission exist during 6 months. Based on presented case authors describe etiopatogenesis of acne and have done rewies of the literature regarding therapy, indications and safety of administration of oral retinoids to children.

Background: Zileuton, a 5-lipoxygenase inhibitor, reduces the number of inflammatory lesions in moderate acne and inhibits the synthesis of sebaceous lipids., Objective: To detect whether zileuton directly reduces sebum synthesis., Methods: A 40-year-old female with mild disseminated sebaceous gland hyperplasia and seborrhea was treated with zileuton 4 x 600 mg/day over 2 weeks, was followed-up for 6 weeks after discontinuation of zileuton and was re-treated with low-dose isotretinoin 10 mg/2nd day over 5 weeks. Casual skin surface lipids and sebum synthesis were determined., Results: Under treatment with zileuton increased casual skin surface lipids were normalized and synthesis of facial sebum was decreased. Six weeks after discontinuation of treatment casual skin surface lipids were increased again and synthesis of sebum returned to baseline. Subsequent low-dose isotretinoin treatment led to similar changes of casual skin surface lipids and sebum synthesis with zileuton already after 2 weeks., Conclusion: Zileuton directly inhibits sebum synthesis in a transient manner with a potency similar to low-dose isotretinoin at least in our patient.

Treatment of SGH by ALA-PDT with Blue Light Source or Intense Pulsed Light Activation. Sebaceous gland hyperplasia (SGH) lesions often present as a sign of photoaging and have proven difficult to treat. Photodynamic therapy (PDT) may be an effective treatment option. Twelve patients with SGH received PDT with 5-aminolevulinic acid (ALA, Levulan Kerastick, DUSA Pharmaceuticals, Inc) photosensitizing agent topically applied with a 30- to 60-minute drug incubation period. Patients received either 405-420 nm blue light (ClearLight PhotoClearing System, CureLight, Lumenis) for 15 minutes or intense pulsed light (IPL), 500-1,200 nm and 550 nm cut-off filter (VascuLight System, Lumenis) according to a randomization protocol. ALA-PDT was administered once per month for 4 consecutive months. Progress was evaluated at 4 and 12 weeks after the final treatment. More than a 50% reduction in the number of SGH lesions was achieved for patients in both treatment arms without lesional recurrence during the treatment and follow-up periods. All treatments were well-tolerated. Adverse effects were limited to mild, transient erythema (n = 2) and blisters (n = 1), which resolved without sequelae. ALA-PDT with either blue light or IPL photoactivation may provide therapeutic benefit without significant adverse effects in patients with SGH.

Topical photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) is a well-established treatment regimen for superficial epithelial skin tumours, but it is evident that inflammatory diseases of the skin and virus-induced lesions can also profit from PDT. Depending on the light dose applied, either cytotoxic effects resulting in tumour destruction or immunomodulatory effects resulting in improvement of inflammatory conditions occur. Patients with localized scleroderma that had been unresponsive to various treatments, including PUVA or bath-PUVA therapy, respond very well to topical ALA-PDT performed repeatedly. In contrast to PUVA therapy, no carcinogenic potential is being discussed for PDT. Also, HPV-induced skin lesions might provide a possible indication for topical ALA-PDT. The rapidly proliferating cells in viral acanthomas accumulate ALA-induced protoporphyrin IX (PPIX) selectively when compared to the surrounding non-infected cells. The efficacy of topical ALA-PDT in the treatment of recalcitrant foot and hand warts has been shown in a placebo-controlled, randomized, double-blind trial. Furthermore, case reports describe a good response of other virus-induced diseases, for example condylomata acuminata and epidermodysplasia verruciformis, to topical PDT with ALA. However, controlled clinical trials are still needed to demonstrate more fully the effectiveness of PDT for inflammatory skin diseases.

A model is proposed which is based on the assumption that acne is due to infection of functionally blocked pilosebaceous follicles by propionibacteria. Noninflamed lesions, which are first visible during the adrenarche in acne-prone individuals, do not contain propionibacteria. Comedogenesis appears to be independent of bacterial infection and may be driven by high levels of bioactive interleukin-1 alpha derived from ductal hyperkeratinocytes. The stimulus which triggers interleukin-1 alpha production is unknown. Formalin killed Propionibacterium acnes failed to stimulate production of the cytokine by cultured human keratinocytes in vitro. Inflamed lesions are thought to arise from microcomedones, but the initiating events are unknown. Evidence that propionibacteria are involved in the generation of inflammatory lesions is inconclusive. The cellular infiltrate is consistent with a type IV hypersensitivity response to one or more persistent lesional antigens, not necessarily bacterial. The potent adjuvant activity of P. acnes would up-regulate the immune response to any antigen which came into contact with the mononuclear cell infiltrate. Antibiotics are widely used in the treatment of acne, and their effects in selecting a predominantly resistant commensal population are well recognized. Although they reduce numbers of propionibacteria on the skin, other modes of action may contribute to or explain their therapeutic efficacy. At a time when there is global concern that antibiotic resistance rates in common bacterial pathogens may threaten our future ability to control bacterial infections, practices which promote the spread of antibiotic-resistant bacteria must be fully justified. A thorough reappraisal of the role of propionibacteria in acne is overdue. It is likely that further experimental work is needed to confirm or refute that P. acnes is aptly named.

Familial sebaceous gland hyperplasia is a benign entity with onset at puberty and a tendency to worsen with age. It is characterized by a nevoid symmetric pattern in the sebaceous areas of the face sparing the orbital, perinasal, preauricular and perioral areas showing prominent follicular openings and interfollicular dermal yellowish or white prominent skin. Usually, the face is affected, with the neck, column and thorax affected in a milder pattern. We describe a family with familial nevoid sebaceous gland hyperplasia in three consecutive generations. All the patients were successfully treated with oral isotretinoin. The pedigree suggests autosomal dominant inheritance with incomplete penetrance.