ADENOMA SEBACEUM¹

Synonyms.—Adenoma of the sebaceous glands; Vegetations vasculaires (Rayer);
Nævi vasculaires et papillaires (Vidal); Adenoma sébacés (Balzer and Ménétrier).

Definition.—A rare affection, consisting of small tumors of
sebaceous gland origin, seated usually on the face, more especially at

¹ Recent literature: Balzer and Ménétrier, Arch, de physiolog., 1885, vol. vi, p. 564
(1 case with histologic cuts); Balzer and Grandhomme (1 case), ibid., 1886, vol. viii, p.
93; Pringle, Brit. Jour. Derm., 1890, p. 1 (with case illustration and photomicrographs,
and a résumé of the above 2 cases and 2 by Vidal and 1 by Hallopeau); Caspary,
Archiv, 1891, vol. xxiii, p. 371 (with literature, references, colored plate, and histo-
logic cuts); Crocker, Trans. Internat. Derm. Cong., Vienna, 1892, p. 505, and Diseases
of Skin, second edit., p. 769; Jamieson, Brit. Jour. Derm., 1893, p. 138 (girl, aged fifteen
—most lesions on right side of forehead close to hair margin); Stopford Taylor and
Barendt, ibid., p. 360 (3 cases in one family—father, son, and daughter, began in all
about the age of five—of defective mental development); Pollitzer, Jour. Cutan. Dis.,
1893, p. 475 (male subject—with case illustration and 2 histologic cuts); Rosenthal
(case demonstration), Monatshefte, 1894, vol. xix, p. 374; Dockrell (case demonstra­
tion), Brit. Jour. Derm., 1895, p. 340 (epileptic boy—some cicatrices present); W. An­
derson, ibid., p. 316 (male subject, aged twenty-seven, began at seven—associated with
fibromata); Brooke, ibid., p. 332 (discussion; 2 cases—1 in idiot girl, the other in epilep­
tic young woman); Perry (case demonstration), ibid., 1896, p. 99 (girl, aged eleven,
with some fibromata); G. H. Fox (case demonstration) (1 case—young girl), Jour.

ADENOMA SEBACEUM

657

the sides of the nose. Originally recorded by Rayer, Addison, and Gull,
it has been more recently described in France by Balzer, in association
with Menetrier and Grandhomme; in England, by Pringle, Crocker, and
others; in Germany, by Caspary, Rosenthai, and a few others; and in
this country by Pollitzer.

Symptoms.—The malady is characterized by small tumors,
which are, as a rule, congenital or appear after birth. In size they vary
from a pin-head to a split pea, are rounded or convex, and may be either
normal skin color, waxy, brownish or reddish—the latter most usually.
The epidermal covering may be smooth, rough, or warty, with, in many
cases, the surface irregularly streaked with ramifying dilated capillaries.

Fig. 155.—Adenoma sebaceum; moderate magnification; showing the striking hyper­
trophy and development of the sebaceous glands (courtesy of Dr. J. A. Fordyce).

This latter character may be, as in Vidal's case, a conspicuous feature.
In fact, their color is measurably influenced by the degree of this asso-

Cutan. Dis., 1897, p. 88; and (2 cases—girls), Trans. Amer. Derm. Assoc. for 1898;
Gottheil, Jour. Amer. Med. Assoc, July 20, 1901, p. 176 (girl, aged nineteen, on one
side of scalp, an area of 2¼ by ¾ inches); Poor, Monatshefte, April 1, 1905, p. 379 (1 case,
with review and literature references), from his study concludes that the cases can be
divided into two classes, called by him: Nævus sebaceus symmetricus and nævus
sebaceus circumscriptus asymmetricus; the former usually on the face, especially the
nose, and its congenital origin is not yet definitely settled; and the latter, on any part
of the body, usually linearly arranged, never symmetrical and always congenital;
Reitmann, Archiv, 1907, vol. lxxxiii, p. 177 (several cases; anatomically the lesions con­
sisted of pathologic formations of connective tissue, without any changes whatsoever
in sebaceous glands); Krzysztalowicz, Monatshefte, 1907, vol. xlv, p. 1 (case, histologic),
considers there are two varieties, one a true hypertrophy of the sebaceous glands which
may undergo degeneration, and a second, which seems to include several pathologic
deviations.

42

658

NEW GROWTHS

dated telangiectasis, although not wholly, as pressure causes but little,
if any, change. They are more or less grouped or bunched at either
side of the nose, with outlying scattered ones, or they may be somewhat
disseminated over the whole facial region, and exceptionally in the scalp.
The acne rosacea regions are, however, its common sites. They are
usually symmetrically distributed. The forehead is rarely the seat of
many lesions, although in some instances those on this region are quite
large. Pollitzer‘s case was exceptional in that the tumors were arranged
in a linear manner, and, as practically likewise in Jamieson‘s case, con­
fined to one side of the forehead. Their appearance and growth are
gradual, the latter usually noted to be more active at about puberty,
at which time especially there may be also a decided increase in num­
bers. Involution may occasionally be noted in some of the growths,
and such may completely disappear, their site being marked by insig­
nificant atrophic spots or scars. Other cutaneous lesions, such as come­
dones, pigment spots, nævi, warts, and fibromata, have been variously
noted, especially the first named, and commonly associated with a coarse,
pasty-looking, large-pored skin. There are no subjective symptoms.

Etiology and Pathology.—The affection is believed to be of
congenital origin, although this does not seem true in all instances; in
Pollitzer‘s case the lesions first presented when aged nineteen. Its
subjects, for the most part, although by no means exclusively, have
been noted to be of defective mental development. It is observed
more frequently, too, among the poorer classes, and Crocker is inclined
to think that more cases could probably be found in asylums. In fact,
according to Colcott Fox,¹ the malady seems to be quite common in
England, and chiefly met with among children in imbecile asylums.

The pathologic anatomy has been studied by Balzer, Pringle, Crocker,
Barendt, Pollitzer, and others, and although there are some minor
divergences, all agree that the process is one of hyperplasia of the se­
baceous glands, and probably, too (Balzer, Crocker), of the sweat-
glands. In fact, Crocker‘s examination disclosed increased develop­
ment of all the appendages,—sebaceous glands, sweat-glands, and hair-
follicles,—and he would prefer to classify it as a pilosebaceous hydrade-
noma. In addition to the hyperplasia of the glandular structures,
Crocker found in one lesion hyperplasia of the fibrous tissue also; Pringle,
the upper papillary layer enormously hypertrophied, but without evi­
dence of inflammation or cellular infiltration; and Balzer, in 1 of his
cases, cysts in both sweat- and sebaceous glands.²

Diagnosis.—The diagnostic features are the early appearance,
the region involved, and the associated telangiectasis and persistent
course. The malady can scarcely be confounded with acne rosacea,
although usually occupying the region of the latter disease, but its early
beginning, lack of pustular tendency, and course are wholly different.
And only careless examination could lead to a confusion with lupus

¹ Colcott Fox (discussion), Jour. Cutan. Dis., 1897, p. 88.

² Krzysztalowicz believes that four types have been recognized: (1) Caspary‘s
sebaceous tumor; (2) Pringle‘s sebaceous, angiomatous, and fibromatous mass; (3)
Darier‘s angiomatous structure; and (4) Perry‘s sweat-gland nævus type.

ADENOMA OF THE SWEAT-GLAND                     659

vulgaris, as the behavior and atrophic or ulcerative tendency of the
latter would be sufficiently differential. There is more resemblance
to multiple benign cystic epithelioma and colloid milium, but the former
develops later in life, is more frequently seated upon the upper part of
the face or upon other regions, especially the upper part of the trunk, and
occasionally tends to superficial ulceration. Colloid milium rarely
involves the lower part of the face, being most commonly on the upper
portion, and the lesions are free from the surface dilated capillaries,
and are, moreover, more distinctly yellow in color. Molluscum con-
tagiosum could be readily differentiated by the central depression and
opening.

Prognosis and Treatment.—In rare instances spontaneous in­
volution has been observed, but this is scarcely to be expected, as the
disease is almost always persistent, the growths usually increasing in
number for a time, and then the malady remaining stationary. Treat­
ment is essentially and solely surgical, as no result has yet been achieved
by local applications or general treatment. If their removal is called
for, it can be accomplished by means of the knife or curet or electrolysis.
This last has been employed successfully by Crocker, using a current
of 3 or 4 milliampères, the procedure being the same as in hypertrichosis
or telangiectasis—the needle attached to the negative pole. Jamieson
effected a removal of the lesions and what seemed to be an apparent
cure by producing exfoliation by rubbing in a paste composed of: R.
Resorcin, gr. xx (1.35); zinci oxidi, gr. xl (2.65); kaolin, gr. ij (0.135);
adipis benzoat, gr. xxviij (1.9).

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