Sebaceous hyperplasia (permanently engorged sebaceous glands) is one of the most challenging skin lesion to treat in dermatology as the roots of the sebaceous glands often extend beyond top layers of the skin.
Photodynamic therapy (PDT) involves application of Levulan for a specified duration followed by exposure to the blue light as prescribed by your board-certified dermatologist. There is significant art and science associated with PDT protocol, i.e. incubation time (the amount of time Levulan is left on the skin) and the exposure time (the subsequent amount of time you are under the blue light therapy). The temporary oxidative stress brought to the skin by PDT can be helpful to eradicate bacteria responsible for acne exacerbation and facilitate sebaceous glands on the skin to respond better to conventional therapy such as oral antibiotics and prescription strength topical therapy.
One will get the best clinical outcome from PDT for sebaceous hyperplasia lesions, if these lesions are pretreated with gentle electrodessication. If oral retinoid is not an option (e.g. women of child-bearing age), potent topical retinoid such as tazoratene can be a nice adjunctive therapy as well.