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Sebaceous Horn (Devil’s Horn): Causes, Symptoms, Risk Factors, Treatment, And Prevention

Recently, a 74-year-old man named Shyam Lal from Madhya Pradesh was diagnosed with a rare medical condition called Sebaceous horn, popularly known as Devil's Horn and has undergone surgery to have the cornified material removed.

According to Shyam Lal, the horn-like projection formed on his head after a head injury, which he had several years ago. Initially, it was small and unusual, but later it grew bigger and seemed like a horn made of wood.

The medical experts find it a rare condition and therefore have sent the case to be published among the rare cases in the International Journal of Surgery. But, what exactly are sebaceous horns? Let's understand it better by knowing its causes, symptoms, risk factors, diagnosis, treatment, and prevention.

What Are Sebaceous Horns?

Sebaceous horns, also known as Cutaneous horns is the unusual conical-shaped projection on the surface of the skin caused due to excessive growth of the epidermis. They are made up of compact keratin and named so as they closely resemble horns of an animal. Sebaceous horns come in variable sizes and shape which ranges from being conical, cylindrical, curved, pointed, or transverse [1] .

Around 60% of sebaceous horns are benign (noncancerous) in nature, but some may cause the risk of skin cancer. They can be seen in body parts like forehead, scalp, nose, ear, lips, penis, neck, eyelids, or sections, which are more exposed to sunlight [2] . The condition is common in both men and women.

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Causes Of Sebaceous Horn

Several factors responsible for the cause of sebaceous horn, but the exact cause is still unknown. However, common known causes for the condition are as follows:

  • Exposure to sunlight radiation, also known as squamous cell carcinoma [1] .
  • Viral warts, especially caused by human papillomavirus [3]
  • Skin cancer
  • Pre-cancerous skin lesions
  • Burn scars
  • Fair skin [4]

Symptoms Of Sebaceous Horn

Sebaceous horns are usually grown on the outside portion of the skin. The growth can be of a different colour, which varies from white, pink, brown, tan, and yellow. They do not cause any symptoms, but horn-shaped projections come out from the skin's surface [1] . When the projections get damaged or injured, then it may cause an infection or pain in the area.

Common characteristics of Sebaceous horns are:

  • A curved horn-like growth on the skin surface
  • Long projections which are twice in length compared to its width
  • In a person, often only one sebaceous horn appears.
  • Size may range from small to larger [2]
  • Surrounded by slightly thickened skin

Risk Factors Of Sebaceous Horn

Whenever a person sees the sign of sebaceous horn, he or she should consult a doctor to understand its causes and know whether it is benign or cancerous. Also, what steps should be taken in case they get injured or inflamed. Benign and nonbenign risk factors associated with the condition are:

  • Skin infections like molluscum contagiosum
  • Bowen's disease [5]
  • Seborrhoeic keratosis
  • Human papillomavirus infection [3]
  • Psoriasis
  • Basal cell carcinoma
  • Arsenical keratosis
  • Intraepidermal carcinoma

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Complications Of Sebaceous Horn

Other possible complications in which a person should contact a doctor are:

  • Pain and inflammation around the sebaceous horn or from it,
  • Bleeding of the sebaceous horn
  • Redness of the sebaceous horn [2]
  • Hardening of the skin around the base
  • Sudden growth of the sebaceous horn
  • A new development of sebaceous horn

Diagnosis Of Sebaceous Horn

A doctor can ask for the medical history of a patient with the sebaceous horn. The diagnosis is based on the appearance of the projection. Secondly, a biopsy is ordered in which a doctor surgically cut a piece of the horn and examine under a microscope whether it is cancerous or not [6] .

Treatment Of Sebaceous Horn

The treatment of sebaceous horn is based on its growth, appearance, and whether it is cancerous or not. The steps for the treatment of benign horns are as follows:

  • Anaesthesia to numb the area around the horn
  • Surgically removing the projection from the base [7]
  • Removing the layers of the skin in case the horn is too deep
  • Closing the area
  • Another method includes, freezing the skin growth with liquid nitrogen [8]

For cancerous sebaceous horns, doctors prefer the following methods:

  • Surgery
  • Scraping or burning of the lesion
  • Chemotherapy [9]
  • Radiation therapy [10]
  • Medicine like imiquimod to stimulate the immune system

Prevention Of Sebaceous Horn

As the main cause of sebaceous horn is long exposure to sunlight, thus avoiding it can be the best way to prevent the condition. Also, apply SPF sunscreen lotions to reduce the risk of a sebaceous horn on the skin.

View Article References
  1. [1] Copcu, E., Sivrioglu, N., & Culhaci, N. (2004). Cutaneous horns: are these lesions as innocent as they seem to be?. World journal of surgical oncology, 2, 18. doi:10.1186/1477-7819-2-18
  2. [2] Phulari, R. G., Rathore, R., Talegaon, T. P., & Shah, A. (2018). Cutaneous horn: A mask to underlying malignancy. Journal of oral and maxillofacial pathology : JOMFP, 22(Suppl 1), S87–S90. doi:10.4103/jomfp.JOMFP_156_17
  3. [3] Sanjeeva, K. K., Ali, P. S., Pinto, M., Rao, S., & Rai, A. S. (2015). Giant Cutaneous Horn Overlying A Verruca at an Uncommon Site: Medical Marvel vs Superstitious Dilemma. Journal of clinical and diagnostic research : JCDR, 9(4), PD13–PD14. doi:10.7860/JCDR/2015/13444.5825
  4. [4] Haddad, C. J., & Haddad-Lacle, J. E. (2014). Cutaneous horn: get to the bottom of it. BMJ case reports, 2014, bcr2014204447. doi:10.1136/bcr-2014-204447
  5. [5] Park, H., Kim, W., Kim, H., & Yeo, H. (2016). Cutaneous Horn in Premalignant and Malignant Conditions. Archives of craniofacial surgery, 17(1), 25–27. doi:10.7181/acfs.2016.17.1.25
  6. [6] Yoon, Y. H., Ju, H. J., Lee, K. H., & Park, C. J. (2016). A Cutaneous Horn-Like Form of Juvenile Xanthogranuloma. Annals of dermatology, 28(6), 783–784. doi:10.5021/ad.2016.28.6.783
  7. [7] Nair, P. A., Kota, R. K., & Pilani, A. P. (2016). Pyogenic granuloma underlying cutaneous horn in a young boy. Indian dermatology online journal, 7(2), 114–116. doi:10.4103/2229-5178.178086
  8. [8] Costa, C., Scalvenzi, M., Ayala, F., Fabbrocini, G., & Monfrecola, G. (2015). How to treat actinic keratosis? An update. Journal of dermatological case reports, 9(2), 29–35. doi:10.3315/jdcr.2015.1199
  9. [9] Joshi, P., Joshi, A., Norohna, V., Prabhash, K., Kane, S., & D'cruz, A. K. (2012). Sebaceous carcinoma and systemic chemotherapy. Indian journal of medical and paediatric oncology : official journal of Indian Society of Medical & Paediatric Oncology, 33(4), 239–241. doi:10.4103/0971-5851.107105
  10. [10] Mokos, I., Mokos, Z. B., Ljubojević, S., Corić, M., Grce, M., & Michal, M. (2012). Penile cutaneous horn ten years after treatment of verrucous squamous cell carcinoma on penile glans: Case report. Acta Dermatovenerol Croat, 20(1), 30-33.

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