Sebaceous Hyperplasia

These are easy to recognise once you know what to look for, and easy to mistake for acne if you do not. They do not hurt, do not itch, and do not change from week to week.

What it looks and feels like

Where it shows up

• The forehead, most commonly.
• The nose and the cheeks.
• The temples.
• The chest and, less often, the neck and shoulders.
• Rarely on the areola, the scrotum or the vulva, where it is normal and needs nothing.

How it looks on different skin tones

On fair skin they read as yellowish and slightly translucent, which is the classic description. On brown and Black skin the yellow is far less obvious, and they often look like skin-coloured or slightly grey-brown bumps instead — so they are more often mistaken for closed comedones or small scars, and more often picked at. The central dip is still there and is the more reliable clue than colour. One practical consequence matters: any treatment that burns or freezes the bump can leave a pale or dark mark on deeper skin that outlasts the bump itself, so gentler settings and treating one test spot first are worth asking for.

Several small bumps look like this and are not. See Lookalikes near the bottom of this page.

Every hair follicle on your face has an oil gland attached to it. The gland is made of cells that fill with oil, burst, and are replaced. That replacement is driven partly by androgens — the hormones that also drive oil production.

As you get older, androgen levels drop, and the cells inside the gland turn over more slowly. Old cells linger instead of being cleared, and the gland gradually enlarges. That enlarged gland pushing up under the skin is the bump you can see. Nothing is trapped, nothing is infected, and nothing has grown abnormally in the way a tumour does — the gland is simply bigger than it should be.

This explains most of what people find confusing about them. They appear in middle age rather than in the teenage years, unlike acne. They do not respond to washing or to squeezing, because there is no plug. And they come back after removal, because the follicle and the tendency are still there. Two other things raise your odds: family history, which is a strong factor, and long-term ciclosporin, the immune-suppressing drug used after organ transplants, which causes them in a large proportion of people who take it. Sun exposure over the years also plays a part.

Worth setting expectations first: nothing you can buy removes these. What follows is honest about what topicals can and cannot do, which is mostly about new bumps rather than existing ones.

Most people never need to. They are harmless and treatment is cosmetic. Book a visit if:

• A bump is new, growing, bleeding, crusting or does not heal. That is the appointment that matters.
• One bump looks different from all the others, or is pearly with visible vessels across it.
• You are not certain what these are.
• You want them removed and would rather it was done properly than attempted at home.

What the visit gets you: a look through a dermatoscope, which separates this from basal cell skin cancer in seconds, and access to the treatments that actually remove them. It also gets you a realistic conversation about recurrence and cost before you start, which is worth having up front.

Prescription creams do a little more than over-the-counter ones and still do not remove an enlarged gland. The one oral option shrinks them while you take it and not after.

This is the band that works. Every option here removes the bump by destroying the enlarged gland, so the choice is mostly about how much marking your skin can afford and how many you have.

Sebaceous hyperplasia is harmless. It does not turn into cancer, does not spread, and causes no symptoms. The things worth knowing are about mistakes and treatment.

Several small facial bumps look like this. The first one on the list is the one that matters.

• Basal cell carcinoma — the important distinction. A pearly bump with fine branching blood vessels across it, often on the nose, cheek or temple. It grows slowly, may bleed or scab and then seem to heal, and then does it again. Sebaceous hyperplasia stays the same size for years and does not bleed. Anything new, growing or bleeding gets checked rather than treated as a blemish.
• Whiteheads (closed comedones) — firmer, white rather than yellow, no central dip, and something does come out with proper extraction. They also respond to retinoids, which sebaceous hyperplasia does not.
• Milia — tiny, firm, pearly white bumps just under the surface, most often around the eyes. Harder and smaller, with no central dip, and easily lifted out with a needle.
• Xanthelasma — flat yellowish patches on the eyelids rather than round bumps. Linked to cholesterol levels, so worth a blood test.
• Syringoma — small skin-coloured bumps in clusters under the eyes, from sweat glands rather than oil glands. Flatter, more numerous, and no central dip.
• Fibrous papule of the nose — a single firm skin-coloured bump on the nose that has been there for years. Harmless, and often confused with both this and basal cell carcinoma.
• Intradermal naevus — a soft skin-coloured mole sitting proud of the skin, often on the face, sometimes with a hair through it. Long-standing and stable.
• Molluscum contagiosum — small pearly bumps with a central dimple, which sounds identical. The differences: they are firmer and shinier, they spread to new areas, they are caused by a virus, and they mostly occur in children and young adults rather than after 40.