Widespread sebaceous hyperplasia on the face of a kidney transplant recipient after the initiation of everolimus treatment

Sebaceous hyperplasia is a benign neoplasm of sebaceous glands. It presents with solitary or multiple yellow-colored papules, and the lesions are usually located on the face. Basal cell carcinoma should be included in the differential diagnosis of sebaceous hyperplasia. Treatment may be required for patients with cosmetic concerns [1].
A 58-year-old male patient was admitted with multiple cutaneous papules on the face for the last 2 months. The past medical history revealed kidney transplantation 9 months ago for end-stage kidney disease caused by polycystic kidney disease. He was initially treated with oral prednisolone 5 mg/day, mycophenolate mofetil 2 g/day, and tacrolimus 2 to 3 mg/day. Unfortunately, his course was plagued with recurrent urinary tract infections, BK viruria (> 10⁸ copies/ml), and elevated creatinine levels. To tackle these issues, he was switched from mycophenolate mofetil to everolimus. The patient stated that the facial lesions first appeared 1 month after the initiation of everolimus treatment and then gradually increased in size and number. In addition, since the lesions were asymptomatic, he did not receive any treatment previously. Dermatological examination revealed multiple skin-colored, yellowish papules with distinct borders on the forehead, malar region, nose, and chin (fig. 1). Dermatoscopic examination of a papule on the forehead revealed white-yellow lobules surrounded by vessels (fig. 2). The papule on the forehead was removed by the punch biopsy technique. The histopathological examination of the specimen revealed sebaceous hyperplasia (fig. 3). Among laboratory tests, complete blood count showed increased basophil count (0.1 × 10³/µl, normal range: 0.01–0.07 × 10³/µl). Biochemistry panel was normal except for the high total serum cholesterol level (210 mg/dl, normal levels: < 200 mg/dl). C-reactive protein level was 1.43 mg/l (normal range: 0–5 mg/l). Complete urinalysis was normal. The blood levels of tacrolimus and everolimus were 6 ng/ml and 5.35 ng/ml, respectively. From a nephrological point of view, his everolimus blood levels were at the desired range, and all his previously mentioned complications had subsided.
Sebaceous hyperplasia is a benign skin neoplasm that results from sebocytes proliferation. It is characterized by yellow-colored, soft, umbilicated papules on the face. The lesions do not lead to any symptoms in most patients; therefore, no treatment is necessary. The diagnosis of sebaceous hyperplasia is usually made based on clinical features; however, a skin biopsy and histological examination may be required to exclude basal cell carcinoma [1]. Sebaceous hyperplasia has been associated with cyclosporine, tacrolimus, and sirolimus use in organ transplant patients [1–4]. Moreover, it has been suggested that drug-related sebaceous hyperplasia might be time- or dose-dependent. For instance, Levandoski et al. reported a kidney transplant patient who had two transplants and received tacrolimus. Nevertheless, the patient developed sebaceous hyperplasia after only the second transplant and, thus, the second course of tacrolimus treatment [2]. On the other hand, Chin and Anstey reported sebaceous hyperplasia due to sirolimus use in a patient with kidney transplant years after the cessation of cyclosporine [4].
Herein, we present a kidney transplant recipient who developed widespread sebaceous hyperplasia on the face 1 month after the initiation of everolimus treatment. To our knowledge everolimus-induced sebaceous hyperplasia has not been previously reported. However, bearing in mind that drug-related sebaceous hyperplasia may be time- or dose-dependent, the possible role of tacrolimus in the development of sebaceous hyperplasia in this patient could not be completely ruled out since he had been receiving tacrolimus for the last 9 months. We suggest that our case will contribute to the literature on the association of medications and sebaceous hyperplasia in kidney transplant recipients, which has not yet been understood.

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Conflict of interest

The authors declare no conflict of interest.

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