Multiple Eruptive Sebaceous Hyperplasia Secondary to Cyclosporin in a Patient with Bone Marrow Transplantation

Eruptive Sebaceous Hyperplasia: A Case Report and Review of the Literature

Introduction

Eruptive sebaceous hyperplasia (ESH) is a benign process characterized by the acute onset and rapid proliferation of sebaceous glands, typically on the face. Although historically attributed to cyclosporine therapy, the preponderance of reports over the past 2 decades suggests a more complex etiology. There is increasing thought a combination of multiple medications as well as a genetic component contribute to ESH's clinical presentation. Despite these theories, the exact cause of ESH in immunosuppressive therapy is poorly understood.

Case Presentation

To our knowledge, we report the third case of ESH arising in multimodality immunosuppressive therapy, consisting of tacrolimus, mycophenolate mofetil, and prednisone, affecting a renal transplant patient. Our patient began cyclosporine monotherapy at an early age but did not see eruption of lesions until years later after following a multimodal therapy.

Conclusion

We discuss the association of ESH with other medical conditions and treatments. We hope this case sheds light on a possible complication of multimodal immunosuppressive therapy in renal transplant patients. This will allow patients and providers to be better informed of the pros and cons of different treatment options for immunosuppressive therapy in renal transplant patients.

Systemic isotretinoin treatment in a renal transplant patient developing sebaceous hyperplasia due to cyclosporine

Sebaceous hyperplasia (SH) is a benign tumor with telangiectasia on it, yellowish or skin-colored, with papulosis. Besides genetic factors, aging, ultraviolet rays, sex hormones, calcineurin inhibitors, such as cyclosporin, tacrolimus and systemic steroids, play a role in the development of sebaceous hyperplasia. Cyclosporin is widely used in organ transplant patients. Acne, keratosis pilaris, sebaceous hyperplasia and epidermoid cysts, which are rare side effects, are frequently seen in renal transplant patients and it is suggested that the pilosebaceous unit develops as a result of occlusion with keratinous material. It is thought that cyclosporine causes these side effects by increasing the secretion of sebum and 5-alpha reductase enzyme activity. In this case study, wepresent here a 36-year-old female patient who had been on cyclosporine treatment for 25 years and had a large number of yellowish, umblike papules on her face for 20 years. She had been diagnosed with cyclosporin triggered by clinical and histopathological findings. The patient was started on 40 mg/day (0.6 mg/kg/day) systemic isotretinoin treatment, and after two months treatment, the patient had almost complete regression of the lesions. Systemic isotretinoin is effective and easy to treat treatment for patients with multiple lesions, especially when compared to other treatments. In addition, all of the cases reported in the literature are male, and this report presents the first female transplant patient with SH, which is induced by cyclosporine use.