Intraoral Sebaceous Gland Hyperplasia

Authors:
Dante Pappano, MD, MPH, and Molly Warren, PA-C
East Tennessee Children’s Hospital

Citation:
Pappano D, Warren M. Intraoral sebaceous gland hyperplasia. Consultant for Pediatricians. 2013;12(11):525.

Sebaceous gland hyperplasia is a common but temporary physiologic disorder in full-term newborns that most often occurs on the nose, cheeks, and upper lips.¹ Much less commonly, it can occur intraorally.

A 2-day-old, 3.9-kg, full-term boy presented to primary care for routine follow-up. The pregnancy, labor, and delivery had been uncomplicated. At presentation, an array of tan-yellow, vesicular-appearing lesions was noted on the mucosa inside the newborn’s lower lip.

There was no history of herpes infection in the mother or other close contacts. Although the newborn was afebrile and was feeding and acting normally, the appearance of vesicular lesions raised concerns about primary herpes simplex virus infection. The patient was sent to our institution’s emergency department for further evaluation.

On intake, the newborn’s temperature was 37°C, heart rate was 164 beats/min, respirations were 62/min, and oxygen saturation was 100%. He appeared well and had normal physical examination findings, except for the presence of roughly a dozen tan-yellow vesicles inside the lower lip.

Because the lesions did not have the appearance of classic herpes lesions, multisite culture testing, lumbar puncture, and intravenous acyclovir administration were deferred. A single herpes culture specimen was obtained from one of the intraoral lesions, with no further intervention.

The patient was discharged with a presumptive diagnosis of sebaceous gland hyperplasia, and a follow-up visit with a pediatric dermatologist was scheduled for the next morning.

The dermatologist the next morning agreed with the diagnosis of sebaceous gland hyperplasia, and no specific care was given. The herpes culture result ultimately was negative.

Sebaceous gland hyperplasia in the newborn, sometimes called Fordyce spots or granules, is a benign condition thought to be related to the effects of maternal androgens.¹ It is an uncommon finding on the oral mucosa in neonates, but one study found it occurring in 1% of a cohort of newborns in Sweden.² 

When hyperplasia occurs on the mucosa, it may appear as vesicular lesions and could prompt unnecessary invasive care. Nevertheless, few images of sebaceous gland hyperplasia appearing on neonatal oral mucosa have been published in the medical literature to educate and guide health care providers about this entity. Our review of numerous pediatric dermatology texts revealed only one image of lesions similar to those of our patient.^3(p508)

References: 

1. Cutaneous disorders of the newborn. In: Paller AS, Mancini AJ, eds. Hurwitz’s Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 4th ed. Philadelphia, PA: Elsevier Saunders; 2011:10-36.
2. Flinck A, Paludan A, Matsson L, Holm A-K, Axelsson I. Oral findings in a group of newborn Swedish children. Int J Paediatr Dent. 1994; 4(2):67-73.
3. Metry DW, Hebert AA. Neonatal mucous membrane disorders. In: Eichenfeld LF, Frieden IJ, Esterlly NB, eds. Neonatal Dermatology. 2nd ed. Philadelphia, PA: Saunders Elsevier; 2008: 503-516.