A Novel Approach to the Treatment of Sebaceous Hyperplasia and Post- Procedural Purpura with Pulsed-Dye Laser

Background: Sebaceous hyperplasia is a benign but clinically and cosmetically unappealing lesion. Historical treatments include cauterization, cryotherapy, chemical ablation, and surgical removal, all of which increase the risk for permanent post-operative adverse effects. The pulsed-dye laser (PDL) offers a safe and effective approach to the treatment of sebaceous hyperplasia in Fitzpatrick skin types I-III, but purpura was an unacceptable trade off of this treatment. We describe a subsequent follow-up treatment aimed at reducing the resulting post-PDL purpura. Methods: Our report presents 5 patients (Fitzpatrick II-III) treated with PDL (595 nm, 5 mm spot, 20 J/cm2, 3 ms) for sebaceous hyperplasia with subsequent follow-up treatment, 24-hours later, with the same PDL (595 nm, 7 mm spot, 9 J/cm2, 6 ms, DCD 30/20) aimed at improving the post-operative purpura. Results: Sebaceous hyperplasia and resulting purpura improved after a single combination treatment session with both high and moderate-fluence PDL. Purpura is required for effective treatment of sebaceous hyperplasia, but is subsequently treated with moderate-fluence PDL 24-hours later, offering complete resolution of post-PDL purpura within 72 hours. Conclusion: Treatment of sebaceous hyperplasia with PDL offers a safe and effective treatment modality aimed at the underlying vasculature associated with the sebaceous gland. The high-fluence and short pulse duration required to remove the sebaceous hyperplasia often leads to the development of purpura. This post-PDL purpura is successfully treated with moderate-fluence PDL with resolution within 72 hours. In the future, we believe that many other conditions requiring high-fluence PDL that leads to purpura may also be treated with a subsequent lower dose treatment to remove any laser induced purpura.