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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for sebaceous hyperplasia and fordyce spots

Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1954 Questions

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Posted on Tue, 4 Apr 2017 in Liver and Gall Bladder
Question: Hello.... I have a question regarding sebaceous hyperplasia, which I have been diagnosed with on my face, and fordyce spots, which I have also been diagnosed with on my lips and inside my cheeks.

Unfortunately, I've been suffering from some health anxiety and made the mistake of consulting "Dr. Google" , which led me to some information about rare familial cancer syndromes Lynch syndrome and XXXXXXX Torre. I'm looking for some reassurances....can you please let me know whether fordyce and sebaceous hyperplasia are quite common, as I understand, and (hopefully) that they are not markers for Lynch syndrome and XXXXXXX Torre? I've just had my first screening colonoscopy done, which was clean, my blood work is normal, as are my yearly Pap smears and mammograms. There is no history of colorectal cancer in my family.

Unfortunately, I have a lighted magnifying mirror and see every spot and blemish on my face! I'm in peri menopause, and was also wondering whether hormonal changes can cause an increase in fordyce and sebaceous hyperplasia spots?

Thank you so much for your input!
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
hormone changes can alter fordyce or hyperplasia.

Detailed Answer:
Helo again,

Fordyce granules or Sebaceous Prominence, are small raised, pale red, yellow-white or skin-colored bumps or spots that appear on the shaft of the penis, the labia, scrotum, or the vermilion border of the lips of a person's face
As per your query the sebacious glands present in body of females are highly senitive to sex hormones.Activity and protrusion depends on the response of sebaceous gland to hormones in blood. However good point is that its not going to effect your health and is just cosmetically important.

If you are over concerned about beauty of your private parts,You can consult an aesthetic surgeon. As almost all spots will be covered by natural skin you will regain your inner beauty.

Please attach few photos high resolution clear picture,So that i can understand the seriousness of cosmetic problem you are having.
These days asthetic surgeries are a good option to regain beauty.

Waiting.
Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar 55 minutes later
Hello again doctor and thank you for you continued care and reassurances! I'm attaching an image of my forehead currently; you'll see hypopigmented areas where my dermatologist zapped the spots of hyperplasia, and there are a few more popping up; also attached is an image of my forehead before they were removed.

I'm also attaching pictures of my lips and inside cheeks with the Fordyce spots which lately seem more prominent.

As I indicated, although I'm taking cymbalta and xanax as needed for anxiety, my health anxiety is in full swing again I believe due to perimenopause changes (I think I will consult a therapist for CBT). I had posed the question regarding a sebaceous hyperplasia/Muir Torre Lind to an oncologist here on this forum and she replied that it is a marker; of course, that response sent me reeling again, although I realize how rare it is and unlikely (again my colonoscopy was completely clean).

I cannot thank you enough for your continued assurances and help....you have truly been a godsen to me! So, sebaceous hyperplasia and Fordyce spots aren't markers for XXXXXXX Torre and Lynch?!!!!
doctor
Answered by Dr. Ramesh Kumar 10 hours later
Brief Answer:
follow up answer.

Detailed Answer:
Hello again,
See dear rare things do occur but are very rare.We can't consider ever rare thing to be a marker of cancer.In medical science we treat a patient symptomatically.For example to explain you better.Slight elevation of blood pressure from normal is of no worries for other wise healthy individual,However if the same patient is lying in ICU even mild changes bear significance.
There are criteria's for every diagnosis,Just having spots does not means that you are susceptible to cancer(Colonoscopy also clear).

Dear as per your question they can be a marker,Just like fever is marker of of infection in body as well as cancer also.But initially when a patient presents with fever we suspect infection and not cancer.
Are you getting me,I am just trying to explain that one marker has no significance.A diagnosis is made after investigation,Symptoms,overall condition of patient plus markers taken together.

Take my words your are normal,However in case you are having cosmetic issues.Aesthetic surgeries can be done to increase beautification.

Though not asked but i feel that over anxiety now is causing obsession in your case.Your mind is preoccupied by the same repeated thoughts again and again.Just reassurance would not help.I think you should take some anxiolytic after consulting a psychiatrist.

Thanks


Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 11 hours later
Hello Dr. XXXXXXX -- thank you once again for your compassion and caring response. I certainly agree with you 100 percent that this current anxiety of mine is borderline obsessive. I've always had health anxiety my whole life (probably made worse more than a decade ago by being misdiagnosed with multiple sclerosis and primary pulmonary hypertension -- I'm still alive and doing well -- other than having chronic fatigue syndrome and fibromyalgia -- you'd think that would have been a lesson for me not to fear the worst!), but I am positive that the recent exacerbation of my anxiety for the last several months is due to hormonal imbalance caused by perimenopause.

I've gotten in touch with my doctor, and we are adding buproprion to the cymbalta which i currently take; I also have alprazolam which I take only as needed, as I realize its addictive potential. I think I am also going to try some cognitive behavioral therapy, as that is covered by my health insurance plan. I have a stressful job, but a wonderful home life with a husband and two young sons, and I need to get back mentally into a good state of mind -- I will work on beating this hypochondria! (At least I admit and know I have that problem -- I suppose that's the first step).

So, leave it to me to consult google over some benign skin conditions and wind up fearing that I have a rare cancer syndrome not definitely linked to either condition -- I read (sorry!) that something like only 200 cases of Muir Torre have ever been diagnosed -- my rational mind sees how ridiculous my thoughts are, but the anxiety always messes that up.

All of my doctors here have reassured me that I do not have those conditions, that makes me feel better for awhile, then I stupidly go back to google, see some tentative link to rare conditions, and I go into a tailspin again (textbook hypochondriac). I promise I will not google health conditions any more (I am so grateful that google did not exist during my pregnancies and when I was wrongly diagnosed with the MS and primary pulmonary hypertension years ago!) Too much information to a medically untrained mind is pure poison!

In any event, please know that you have been a blessing to me and I cannot thank you enough for your compassion and reassurances -- I will do whatever is necessary to beat this health anxiety! If you were a physician here in the US, I would love to be your patient (although you'd probably shudder at the thought of me as a patient with my neurotic questions!)

Thank you a million times over for your reassurance and concern Dr. XXXXXXX -- you are a very special person! Have a wonderful day!
doctor
Answered by Dr. Ramesh Kumar 25 minutes later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello again,
Firstly thank you so much Dear and i wish you a very happy and stress free life ahead.

Though not asked yet few suggestions are-
Switch over to Etizolam from Alprazoram(Xanax),Various studies and trails conducted by NCBI shows that-Etizolam have much lower dependence potential than other benzodiazepines like Xanax.
Although etizolam is clinically regarded as a benzodiazepine because of its mode of action via benzodiazepine receptor.The potency and efficacy of etizolam for potentiation of Aminobutyric acid evoked Cl− current mediated by recombinant α1 β2 γ2S receptors is MUCH LOWER than those of classical benzodiazepines.This is a reason for reduced liability of etizolam for the development of tolerance and dependence.

Certain medications can help control the obsessions and compulsions.In your case fear of rare cancer is your obsession which leads your mind to google things again and again(compulsion),Despite of assurance by so many competent doctors.I would strongly recommend you to take therapy with Paroxetine for atleast 3 months.Paroxetine is a selective serotonin reuptake inhibitor. Serotonin is a neurotransmitter a chemical that relays signals between the cells in your brain. SSRIs increase the amount of serotonin in your brain, and by increasing the levels of serotonin it helps relieving obsessive symptoms.Take my advice ask your GP to start you on low dose paroxetine for 21 days,Believe me it can play wonders.

Lactium is a milk protein hydrolysate and is natural product extracted from cows milk. Lactium is very effective in treating anxiety.

Please discuss option with your primart consultant.
Have you ever tried SSRI'S?
Who suggested you Alprax on SOS basis?
Do you feel relieved by it?

Again thanks a lot for praises.
Wish you great health.
Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ramesh Kumar 46 minutes later
Hi Doctor!

I must say, I have so much enjoyed corresponding with you -- you are a delightful doctor and I feel as though I have a friend on the other side of the continent!

Actually, I have been on SSRIs for probably the past twelve years or so, sometimes switching between them. For the past five years, I have been on duloxetine, to help with not only the anxiety but also for pain relief relating to fibromyalgia. Unfortunately, around this time last year, I wanted to wean off of duloxetine under my doctor's direction, which i did; long story short, it sent me into a tailspin of anxiety, and I thereafter, after trying different versions of the SSRIs (prozac, lexapro, etc) went back on duloxetine (an SNRI) which has offered me relief. However, as I indicated, I'm not sure whether it has the same efficacy for me with my perimenopausal hormonal changes, so my doctor just added to it buproprion, which I just started this morning. The alprazolam I take as needed for really bad days. I'm hoping the adjustment in my meds helps on a daily basis; if it does not, I'll continue trying different options, and again, I'm definitely going to look into cognitive behavioral therapy.


By the way, anxiety runs in my family -- both of my parents, grandparents, siblings all suffered from it (as a matter of fact, I think my dad and his mom both suffered from nervous breakdowns). I'm so grateful that there are medications out there like the SSRIs and SNRIs. As I am sure you have figured out by now, I am your classic overthinker, and I have to work on shutting off my mind when it starts straying toward the medical stuff, and redirect it toward thinking about all of the blessings which I have in my life.

As an aside, my dad was an absolutely brilliant mind, had a photographic memory, and was also a classic overthinker. After he suffered a heart attack and had bypass surgery, his heart muscle was damaged as a result of the attack; the doctors implanted a defibrillator, which subsequently had to be removed because he developed an infection, and he never had another one implanted. His cardiologist told him in no uncertain terms that he was subject to sudden death at any point in time; you can only imagine what that did to my father's state of mind and his health anxiety -- he lived in fear every single day, and unfortunately, that's what ultimately took his life back in 2006.

The mind can be a very powerful thing!

God bless you so very much doctor, you are truly an XXXXXXX in my opinion!

And here's a happier picture of me from across the world to say thank you and god bless you doctor!!
doctor
Answered by Dr. Ramesh Kumar 10 hours later
Brief Answer:
Proper tretment can make things much better,

Detailed Answer:
Hello again,
Thanks you once again and keep smiling always.You have got a beautiful smile.
I am really sorry for your father,May his soul rest in peace.

Now as per your history Duloxetine is a SNRI and has a number of side effects like extreme drowsiness,Nausea and severe constipation.Most of the patient don't do well on Duloxetine.Instead i would suggest you to discuss with your primary options of Paroxetine,In Practical experience A very safe and highly effective drug when taken in correct doses,Far superior to SNRI's,with minimum side effects.

Secondly habit formation is very rarely observed in case of Etizolam(reason explained above),So my advice not as a doctor but as a friend is that ask your primary to start you on low doses of paroxetine with etizolam initially daily to be tappered to as and when required after 2 weeks.
For paroxetine to be effective,doses are very crucial.12.5mg initially to be increased at at a rate of 12.5mg every 2 weeks taking it to maximum doses of 50mg once daily for 2 months and then weaning it off every 2 weeks is the protocol.(discuss this protocol with your primary).

Tetramethyl folate supplement should also be taken along with this therapy.

Try this and you will start feeling the change in less then 21 days.

After conversing with you,I don't feel that you were treated properly by your Primary.
Paroxetine can play wonders,Take my words and you will be much better soon friend.

In case you have any further query,I would be gald to help you.

Regards,
Kumar.
Above answer was peer-reviewed by : Dr. Remy Koshy
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