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Sebaceous Hyperplasia Effectively Improved by the Pin-Hole Technique with Squeezing

Authors:
Letter to the Editor
Vol. 25, No. 2, 2013 257
Received May 4, 2012, Revised July 31, 2012, Accepted for publication August 28, 2012
Corresponding author: Jin-Soo Kang, Kangskin Clinic, Kanghanmi Bd, 304 Seocho-daero, Seocho-gu, Seoul 137-881, Korea. Tel: 82-2-584- 9007, Fax:
82-2-585-4920, E-mail: kangskin@hanmail.net
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his is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:/
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http://dx.doi.org/10.5021/ad.2013.25.2.257
Sebaceous Hyperplasia Effectively Improved by the
Pin-Hole Technique with Squeezing
Jae-Hong Kim, Hwa-Young Park, Won-Soo Lee, Jin-Soo Kang
1
Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju,
1
Kangskin Clinic, Seoul, Korea
Dear Editor:
Sebaceous hyperplasia (SH) is a common benign skin
lesion composed of sebaceous glands. It is characterized
by a yellow or flesh-toned papule that is commonly found
on the face
1
. Treatment of SH is usually for the cosmetic
reasons only. Although many kinds of treatment modalities
have been applied to treat SH, a successful, long-standing
eradication of SH remains difficult
2
.
A 55-year-old man presented with a several-year history of
multiple papules on the face. Physical examination reveal-
ed multiple yellow or flesh-toned papules on both cheeks
and lateral canthus (Fig. 1A). Magnification with dermato-
scopy showed yellowish papules with overlying telangiec-
tasias. He did not present with subjective symptoms that
are frequently associated with skin lesions. On the basis of
clinical findings, the patient’s condition was diagnosed as
SH. After 1-hour application of topical anesthesia (EMLA
cream, AstraZeneca AB, Södertälje, Sweden), we made a
small, 1 mm diameter opening in each papule using the
carbon dioxide laser, then squeezed the papules using an
acne extractor to induce shrinkage of the sebaceous
lobules. Sebaceous contents were easily discharged
through the small papule openings, and the size of the
lesions decreased after squeezing. After squeezing, the
small papule openings were shot by the carbon dioxide
laser to remove the shrunken sebaceous lobules. The
treatment was tolerable to the patient, and there were no
bleeding or other signs of severe tissue damage. Most of
the lesions were flattened after the procedure, and small
crusts made by the carbon dioxide laser disappeared after
10 days of the treatment (Fig. 1B). After 3 months of the
treatment, there were neither signs of recurrence nor
specific side-effects related to the treatment.
Various treatment modalities for SH have been used such
as isotretinoin, cryosurgery, the pulsed-dye laser, and the
carbon dioxide laser
2-5
. However, a long duration of
down-time between treatments is necessary, as various
kinds of laser therapy and cryosurgery inevitably cause
epidermal damage. In addition, adverse effects such as
persistent erythema, edema, infection, and persistent
hyperpigmentation are not uncommon. Although the
non-ablative lasers and isotretinoin can be used to avoid
these limitations, the high cost may be a burden to
patients. In this case, we used a simple method that
required making an opening in the multiple SHs, using a
carbon dioxide laser, with the subsequent squeezing by
an acne extractor. Different from the conventional uses of
the carbon dioxide laser, we used the laser only to make
very small openings and to eradicate the shrunken
sebaceous lobules. Because we made minimal epidermal
changes, there were no side-effects related to the laser
treatment such as persistent erythema, edema, infection,
and persistent hyperpigmentation. In addition, the patient
did not feel discomfort during the procedure.
In summary, we report a case of SH that was effectively
improved by the pin-hole technique with the carbon
dioxide laser. We think that this method may be used as
an alternative therapy for the treatment of SH. Further
study is warranted to determine the longevity of the
clinical results observed.
Letter to the Editor
258 Ann Dermatol
Fig. 1. (A) Multiple yellow o
r
flesh-toned papules on both cheeks
and lateral canthus. (B) Most
lesions disappeared after 10 days
of treatment.
REFERENCES
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2. Kim SK, Do JE, Kang HY, Lee ES, Kim YC. Combination of
topical 5-aminolevulinic acid-photodynamic therapy with
carbon dioxide laser for sebaceous hyperplasia. J Am Acad
Dermatol 2007;56:523-524.
3. Burton CS, Sawchuk WS. Premature sebaceous gland hyper-
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Dermatol 1985;12:182-184.
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... Many treatment modalities with varying cosmetic and treatment results have been suggested for the removal of SH lesions, including systemic isotretinoin (2), topical trichloroacetic acid (3), cryotherapy (4), intralesional electrodessication (5), shave excision and curettage (6), photodynamic therapy (7), and laser therapy (8)(9)(10)(11)(12)(13)(14)(15)(16). ...
... Kim et al. (13) introduced a simple procedure in a 55-year-old man with multiple SH lesions using the pinhole method with a CO2 laser and acne extractor. This method appears to be somewhat similar to the method discussed in this article, but it requires skilled hands and reports lack a sufficient sample size. ...
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Introduction: Sebaceous hyperplasia (SH) is a common cutaneous disorder associated with cosmetic problems. Some optional treatments and various laser devices have been reported to be effective, but recurrence and cosmetic outcome have not been resolved. Methods: This interventional study was performed on SH lesions. First, the lesions were treated with a CO2 laser, and then the shrunken lesions were removed with a fine, sharp curette. Results: A total of 46 patients (32 females and 14 males, mean age 39.9 ± 5.7 years) with SH skin lesions varying in severity were included in this study. The mean time of repair was 11.5 ± 1.9 days; a shorter repair time was seen in females and for mild extension lesions (p < 0.001). A fair cosmetic outcome was seen in 76.1% of cases, with better results reported for females and for skin types II and III (p < 0.001). Conclusions: The method reported herein is an easy, rapid, and effective procedure for the complete removal of SH lesions with few complications in the majority of patients with numerous lesions and Fitzpatrick skin types II-IV. Cosmetic outcomes are better in females and skin types II and III.
... Although various treatment options are available for self-inflicted scars, such as elliptical excision of the lesion in a single session, dermabrasion, tattooing over the scarred area, and various types of lasers including pulsed dye laser (PDL) and the non-ablative fractional laser, these conventional scar correction techniques and treatment modalities may not effectively change the unique scar pattern [3]. The pinhole method is a CO 2 laser treatment technique that has proved effective in various dermatologic diseases such as sebaceous hyperplasia, anetoderma, and elastosis perforans serpiginosa [4][5][6]. The pinhole method could be an option to treat linear scars, and we previously reported mild to moderate improvement of scar appearance with the pinhole method [7]. ...
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Scars from self-inflicted wounds, referred to as "hesitation marks," are usually linear, flat, poorly oriented, white in color, and often located on the forearm. Many patients do not undergo treatment for these due to limited available modalities. The aim of this study was to evaluate the efficacy and safety of the pinhole method using a 10,600 nm carbon dioxide (CO2) laser for treating hesitation marks on the forearm. We conducted a retrospective chart review of patients with hesitation marks treated by the pinhole method from March 2010 to April 2014. Eleven patients with hesitation marks (mean age 37.8 years; range, 23-67 years) were treated with the pinhole method over the 4-year study period. Subjects were treated via the pinhole method in one to six treatment sessions at 4- to 8-week intervals. Two blinded observers evaluated photographs taken at baseline and 3 months after the final treatment and assessed improvement using a quartile grading scale. Compared with baseline, there was mild to moderate improvement in all patients (mean score 3.0). The patient satisfaction survey revealed a mean improvement score of 2.82. The pinhole method using a CO2 laser may be an effective treatment option in patients with hesitation marks on the forearm.
... The pinhole method is a CO 2 laser treatment technique that has proven its effectiveness on various dermatologic diseases, such as sebaceous hyperplasia, anetoderma, and elastosis perforans serpiginosa [17][18][19]. It makes multiple small holes like sweat pores that penetrate from the epidermis to the papillary dermis at intervals of 0.2-0.5 cm [14]. ...
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Background Hypertrophic burn scars induce cosmetic and functional complications. Although there are various treatment modalities, an ideal method has not yet been found. Recently, numerous laser treatment modalities have been introduced with encouraging results.Objective To assess the efficacy and safety of combination therapy with laser-cision and pinhole method using a carbon dioxide (CO2) laser.Methods We conducted retrospective chart review of patients with hypertrophic burn scars treated by combination laser-cision and pinhole method from January 2007 to December 2012.ResultsNine patients with hypertrophic burn scars (mean age 31.2 years; range, 13–52 years) were treated with combination therapy over the past 6 years. Subjects were treated with one to three treatment sessions at 1-year intervals by laser-cision and five to eight treatment sessions at 2- to 3-month intervals by pinhole method. Two blinded observers evaluated photographs taken at baseline and 6 months after the final treatment. Compared with baseline, there was a mild to moderate improvement in all the patients (Grades 1–4; mean score: 2.89). The patient satisfaction survey revealed a mean improvement score of 3.11.Conclusion Combination laser-cision and pinhole method using a CO2 laser may be a new effective treatment option for patients with hypertrophic burn scars. Lasers Surg. Med. © 2014 Wiley Periodicals, Inc.
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