Fordyce spots

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2].

Synonyms and Keywords: Fordyce granules; Fordyce disease; Fordyce bodies.

Overview

Fordyce spots (also termed Fordyce granules,[1] or Fordyce disease),[1][2] are visible sebaceous glands that are present in most individuals. They appear on the genitals and/or in the mouth. They appear as small, painless, raised, pale, red or white spots or bumps 1 to 3 mm in diameter that may appear on the scrotum, shaft of the penis or on the labia, as well as the inner surface (retromolar mucosa) and vermilion border of the lips of the face. They are not associated with any disease or illness, nor are they infectious but rather they represent a natural occurrence on the body. No treatment is therefore required, unless the individual has cosmetic concerns. Persons with this condition sometimes consult with a dermatologist because they are worried they may have a sexually transmitted disease (especially genital warts) or some form of cancer.[3]

Classification

Sebaceous glands are normal adnexal structures of the dermis but may also be found ectopically within the mouth, where they are referred to as Oral Fordyce Granules or ectopic sebaceous glands. On the foreskin they are called Tyson's glands,[4] not to be confused with hirsuties coronae glandis.[5]

When they appear on the penis, they are also called penile sebaceous glands.[6]

When seen as a streak of individual glands along the interface between the skin of the lip and the vermilion border, the terms Fox-Fordyce disease and Fordyce's condition have been used.

Signs and symptoms

On the shaft of the penis, Fordyce spots are more visible when the skin is stretched, and may only be noticeable during an erection.[6] The spots can also appear on the skin of the scrotum.[6]

Oral Fordyce granules appear as rice-like granules, white or yellow-white in color. They are painless papules (small bumps), about 1–3 mm in greatest dimension. The most common site is along the line between the vermilion border and the oral mucosa of the upper lip, or on the buccal mucosa (inside the cheeks) in the commissural region,[1] often bilaterally. They may also occur on the mandibular retromolar pad and tonsillar areas, but any oral surface may be involved. There is no surrounding mucosal change. Some patients will have hundreds of granules while most have only one or two.

Occasionally, several adjacent glands will coalesce into a larger cauliflower-like cluster similar to sebaceous hyperplasia of the skin. In such an instance, it may be difficult to determine whether or not to diagnose the lesion as sebaceous hyperplasia or sebaceous adenoma. The distinction may be moot because both entities have the same treatment, although the adenoma has a greater growth potential. It should be mentioned that sebaceous carcinoma of the oral cavity has been reported, presumably arising from Fordyce granules or hyperplastic foci of sebaceous glands.

In some persons with Fordyce spots, the glands express a thick, chalky discharge when squeezed.[6]

Causes

Normally, sebaceous glands are only found in association with a hair follicle.

They appear to be more obvious in people with greasy skin types, with some rheumatic disorders, and in Hereditary nonpolyposis colorectal cancer.[1] In the latter, the most common site for Fordyce spots is the lower gingiva (gums) and vestibular mucosa.[1]

Differentiating Fordyce spots drom other diseases

Disease Presentation Risk Factors Diagnosis Affected Organ Systems Important features Picture
Diseases predominantly affecting the oral cavity
Oral Candidiasis
  • Denture users
  • As a side effect of medication, most commonly having taken antibiotics. Inhaled corticosteroids for the treatment of lung conditions (e.g, asthma or COPD) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
  • Clinical diagnosis
  • Confirmatory tests rarely needed
Localized candidiasis

Invasive candidasis

Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg
Herpes simplex oral lesions
  • Stress
  • Recent URTI
  • Female sex
  • The symptoms of primary HSV infection generally resolve within two weeks
Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg
Aphthous ulcers
  • Painful, red spot or bump that develops into an open ulcer
  • Physical examination
  • Diagnosis of exclusion
  • Oral cavity
  • Self-limiting , Pain decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358
Squamous cell carcinoma Squamous cell carcinoma
Leukoplakia
  • Vulvar lesions occur independent of oral lesions
Leukoplakia
Melanoma Oral melanoma
Fordyce spots Fordyce spots
Burning mouth syndrome
Torus palatinus Torus palatinus
Diseases involving oral cavity and other organ systems
Behcet's disease Behcet's disease
Crohn's disease
Agranulocytosis
Syphilis[9] oral syphilis
Coxsackie virus
  • Symptomatic treatment
Hand-foot-and-mouth disease
Chicken pox Chickenpox
Measles
  • Unvaccinated individuals[10][11]
  • Crowded and/or unsanitary conditions
  • Traveling to less developed and developing countries
  • Immunocompromized
  • Winter and spring seasons
  • Born after 1956 and never fully vaccinated
  • Health care workers
Koplick spots (Measles)


Diagnosis

Large numbers of lobules coalescing into a definitely elevated mass may be called benign sebaceous hyperplasia, and occasional small keratin-filled pseudocysts may be seen and must be differentiated from epidermoid cyst or dermoid cyst with sebaceous adnexa. The pathologist must be careful to differentiate such lesions from salivary neoplasms with sebaceous cells, such as sebaceous lymphadenoma and sebaceous adenoma, and their malignant counterparts sebaceous lymphadenocarcinoma and sebaceous carcinoma.

Oral Fordyce granules are usually not biopsied because they are readily diagnosed clinically, but they are often seen as incidental findings of mucosal biopsies of the buccal, labial and retromolar mucosa. The granules are similar to normal sebaceous glands of the skin but lack hair follicles and almost always lack a ductal communication with the surface. The glands are located just beneath the overlying epithelium and often produce a local elevation of the epithelium. Individual sebaceous cells are large, with central dark nuclei and abundant foamy cytoplasm. The surrounding stroma may contain occasional chronic inflammatory cells because of trauma with adjacent teeth.

Physical examination

Gallery

Head

Prognosis

Fordyce spots are completely benign,[1] and require no treatment. Often their presence is considered normal anatomic variants rather than a true medical condition.

Treatment

Vaporising laser treatments such as CO2 laser[12] or electro desiccation have been used with some success in diminishing the appearance of this condition if they are of cosmetic concern, despite the fact that most doctors consider this a normal physiological phenomenon and advise against treatment.[13]

Success varies per patient, but some have found relief from pulsed dye Lasers,[14] a laser normally used to treat sebaceous gland hyperplasia,[15] which is similar to Fordyce spots. Treatment with pulsed dye lasers is expensive, but may be less likely to scar than other methods.[15]

No treatment is required for oral Fordyce granules, except for cosmetic removal of labial lesions if the individual wishes it. Inflamed glands can be treated topically with clindamycin. When surgically excised they will not recur. Neoplastic transformation is very rare but has been reported.

Epidemiology

This variation of normal anatomy is seen in the majority of adults. It is estimated about 80% of people have oral Fordyce spots,[1] but seldom are granules found in large numbers. They are not usually visible in children, and tend to appear at about age 3, then increasing during puberty and become more obvious in later adulthood.[1] They are more prominent in males.[1] Examples reported in a cancer screening represent approximately 1% of adults.

History

They are named after an American dermatologist, John Addison Fordyce.[16]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Scully C (2013). Oral and maxillofacial medicine : the basis of diagnosis and treatment (3rd ed.). Edinburgh: Churchill Livingstone. pp. 170, 392. ISBN 978-0-7020-4948-4.
  2. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.Template:Pn
  3. Palo Alto Medical Foundation Bettina McAdoo , M.D. Retrieved June 24, 2006.
  4. derm/395 at eMedicine
  5. Khoo LS, Cheong WK (July 1995). "Common genital dermatoses in male patients attending a public sexually transmitted disease clinic in Singapore". Annals of the Academy of Medicine, Singapore. 24 (4): 505–9. PMID 8849177.
  6. 6.0 6.1 6.2 6.3 Rane V, Read T (May 2013). "Penile appearance, lumps and bumps". Australian Family Physician. 42 (5): 270–4. PMID 23781523.
  7. Ann M. Gillenwater, Nadarajah Vigneswaran, Hanadi Fatani, Pierre Saintigny & Adel K. El-Naggar (2013). "Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!". Advances in anatomic pathology. 20 (6): 416–423. doi:10.1097/PAP.0b013e3182a92df1. PMID 24113312. Unknown parameter |month= ignored (help)
  8. Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). "Idiosyncratic drug-induced agranulocytosis: Update of an old disorder". Eur J Intern Med. 17 (8): 529–35. Text "pmid 17142169" ignored (help)
  9. title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"
  10. Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE (2000). "Individual and community risks of measles and pertussis associated with personal exemptions to immunization". JAMA. 284 (24): 3145–50. PMID 11135778.
  11. Ratnam S, West R, Gadag V, Williams B, Oates E (1996). "Immunity against measles in school-aged children: implications for measles revaccination strategies". Can J Public Health. 87 (6): 407–10. PMID 9009400.
  12. Ocampo-Candiani J, Villarreal-Rodríguez A, Quiñones-Fernández AG, Herz-Ruelas ME, Ruíz-Esparza J (August 2003). "Treatment of Fordyce spots with CO2 laser". Dermatologic Surgery. 29 (8): 869–71. doi:10.1046/j.1524-4725.2003.29236.x. PMID 12859392.
  13. Nordqvist, Christian (February 27, 2013). "What Are Fordyce Spots? What Causes Fordyce Spots?". Medical News Today.
  14. http://sebaceous.proboards42.com/index.cgi?board=real&action=display&thread=249&page=5[full citation needed]
  15. 15.0 15.1 Schönermark MP, Schmidt C, Raulin C (1997). "Treatment of sebaceous gland hyperplasia with the pulsed dye laser". Lasers in Surgery and Medicine. 21 (4): 313–6. doi:10.1002/(SICI)1096-9101(1997)21:4<313::AID-LSM1>3.0.CO;2-T. PMID 9328977.
  16. Fordyce first described this condition in 1896.synd/1510 at Who Named It

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