Fordyce spots

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Fordyce spots
Fordyces spot closeup.jpg
Close-up of Fordyce spots on penis (shaft)
Fordyce's Spots on Vulva.png
Fordyce spots on vulva
Anatomical terminology

Fordyce spots (also termed Fordyce granules) are harmless and painless visible sebaceous glands typically appearing as white/yellow small bumps or spots on the inside of lips or cheeks, gums, or genitalia. [1] [2] They are common, [3] and are present in around 80% of adults. [1] Treatment is generally not required and attempts to remove them typically result in pain and scarring. [3]

Contents

Their cause is unclear, [3] and they are not associated with hair follicles. [3] Diagnosis is done by visualisation. [3] They may appear similar to genital warts or molluscum. [3] They were first described in 1896 by American dermatologist John Addison Fordyce. [4]

History

Fordyce spots are named after the American dermatologist John Addison Fordyce, who first described them in 1896. [5]

Classification

Sebaceous glands are normal structures of the skin but may also be found ectopically in the mouth, where they are referred to as oral Fordyce granules or ectopic sebaceous glands. On the foreskin, they are called Tyson's glands, [6] but should not be confused with hirsuties coronae glandis. [7]

When they appear on the penis, they are called penile sebaceous glands. [8]

Signs and symptoms

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. Therefore, no treatment is required. People with this condition sometimes consult a dermatologist because they are worried they may have a sexually transmitted infection (especially genital warts) or some form of cancer. [9]

Description

Fordyce spots on scrotum Mancha de Fordyce.jpg
Fordyce spots on scrotum
Fordyce spots on lips Fordyce Spots on Lips.jpg
Fordyce spots on lips

On the shaft of the penis, Fordyce spots are more visible when the skin is stretched, and may only be noticeable during an erection. [8] The spots can also appear on the skin of the scrotum. [8]

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, [10] 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.[ citation needed ]

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. Sebaceous carcinoma of the oral cavity has been reported, presumably arising from Fordyce granules or hyperplastic foci of sebaceous glands.[ citation needed ]

In some persons with Fordyce spots, the glands express a thick, chalky discharge when squeezed. [8]

Causes

They appear to be more obvious in people with oily skin types, with some rheumatic disorders, and in hereditary nonpolyposis colorectal cancer. [10] In the latter, the most common site for Fordyce spots is the lower gingiva (gums) and vestibular mucosa. [10]

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 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.

Differential

Some diseases may appear similar to Fordyce spots such as sexually transmitted infections. [11]

Prognosis

Fordyce spots are completely benign [10] and require no treatment. They occur in 70 to 80 percent of adults. [12]

Epidemiology

They are present in around 80% of adults. [1] 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. [10] They are more prominent in males. [10]

Related Research Articles

<span class="mw-page-title-main">Sebaceous hyperplasia</span> Medical condition

Sebaceous hyperplasia is a disorder of the sebaceous glands in which they become enlarged, producing flesh-colored or yellowish, shiny, often umbilicated bumps. Sebaceous hyperplasia, primarily affecting older patients in high-concentration areas like the face, head, and neck, typically has a 2-4 mm diameter and causes no symptoms. The lesions are often surrounded by telangiectatic blood vessels, also known as "crown vessels," and a central dell, which is in line with the origin of the lesions.

<span class="mw-page-title-main">Sebaceous gland</span> Gland to lubricate the hair and skin

A sebaceous gland or oil gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest number on the face and scalp, but also on all parts of the skin except the palms of the hands and soles of the feet. In the eyelids, meibomian glands, also called tarsal glands, are a type of sebaceous gland that secrete a special type of sebum into tears. Surrounding the female nipples, areolar glands are specialized sebaceous glands for lubricating the nipples. Fordyce spots are benign, visible, sebaceous glands found usually on the lips, gums and inner cheeks, and genitals.

<span class="mw-page-title-main">Nevus</span> Mole or birthmark; visible, circumscribed, chronic skin lesion

Nevus is a nonspecific medical term for a visible, circumscribed, chronic lesion of the skin or mucosa. The term originates from nævus, which is Latin for "birthmark"; however, a nevus can be either congenital or acquired. Common terms, including mole, birthmark, and beauty mark, are used to describe nevi, but these terms do not distinguish specific types of nevi from one another.

<span class="mw-page-title-main">Epidermoid cyst</span> Benign cyst usually found on the skin

An epidermoid cyst or epidermal inclusion cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium.

<span class="mw-page-title-main">Erythroplakia</span> Medical condition

Erythroplakia is a clinical term to describe any erythematous (red) area on a mucous membrane, that cannot be attributed to any other pathology.

<span class="mw-page-title-main">Milium (dermatology)</span> Medical condition

A milium, also called a milk spot or an oil seed, is a clog of the eccrine sweat gland. It is a keratin-filled cyst that may appear just under the epidermis or on the roof of the mouth. Milia are commonly associated with newborn babies, but may appear on people of any age. They are usually found around the nose and eyes, and sometimes on the genitalia, often mistaken by those affected as warts or other sexually transmitted diseases. Milia can also be confused with stubborn whiteheads.

<span class="mw-page-title-main">Stomatitis</span> Inflammation of the mouth and lips

Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration.

<span class="mw-page-title-main">Pityriasis rubra pilaris</span> Medical condition

Pityriasis rubra pilaris refers to a group of chronic disorders characterized by reddish orange, scaling plaques and keratotic follicular papules. Symptoms may include reddish-orange patches on the skin, severe flaking, uncomfortable itching, thickening of the skin on the feet and hands, and thickened bumps around hair follicles. For some, early symptoms may also include generalized swelling of the legs, feet and other parts of the body. PRP has a varied clinical progression and a varied rate of improvement. There is currently no known cause or cure for PRP.

<span class="mw-page-title-main">Comedo</span> Medical condition

A comedo is a clogged hair follicle (pore) in the skin. Keratin combines with oil to block the follicle. A comedo can be open (blackhead) or closed by skin (whitehead) and occur with or without acne. The word "comedo" comes from the Latin comedere, meaning "to eat up", and was historically used to describe parasitic worms; in modern medical terminology, it is used to suggest the worm-like appearance of the expressed material.

<span class="mw-page-title-main">Pearly penile papules</span> Small bumps on the head of the human penis

Pearly penile papules are benign, small bumps or spots on the human penis. They vary in size from 1–4 mm, are pearly or flesh-colored, smooth and dome-topped or filiform, and appear in one or, several rows around the corona, the ridge of the head of the penis and sometimes on the penile shaft. They are painless, non-cancerous and not harmful. The medical condition of having such papules is called hirsutoid papillomatosis or hirsuties papillaris coronae glandis.

The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed lamina propria. The oral cavity has sometimes been described as a mirror that reflects the health of the individual. Changes indicative of disease are seen as alterations in the oral mucosa lining the mouth, which can reveal systemic conditions, such as diabetes or vitamin deficiency, or the local effects of chronic tobacco or alcohol use. The oral mucosa tends to heal faster and with less scar formation compared to the skin. The underlying mechanism remains unknown, but research suggests that extracellular vesicles might be involved.

<span class="mw-page-title-main">Cheilitis</span> Inflammation of the lips

Cheilitis is a medical condition characterized by inflammation of the lips. The inflammation may include the perioral skin, the vermilion border, or the labial mucosa. The skin and the vermilion border are more commonly involved, as the mucosa is less affected by inflammatory and allergic reactions.

<span class="mw-page-title-main">Tinea nigra</span> Medical condition

Tinea nigra, also known as superficial phaeohyphomycosis and Tinea nigra palmaris et plantaris, is a superficial fungal infection, a type of phaeohyphomycosis rather than a tinea, that causes usually a single 1–5 cm dark brown-black, non-scaly, flat, painless patch on the palms of the hands and the soles of the feet of healthy people. There may be multiple spots. The macules occasionally extend to the fingers, toes, and nails, and may be reported on the chest, neck, or genital area. Tinea nigra infections can present with multiple macules that can be mottled or velvety in appearance, and may be oval or irregular in shape. The macules can be anywhere from a few mm to several cm in size.

<span class="mw-page-title-main">Vermilion border</span> Border between the lips and the rest of the face

The vermilion border, also called margin or zone, is the normally sharp demarcation between the lip and the adjacent normal skin. It represents the change in the epidermis from highly keratinized external skin to less keratinized internal skin. It has no sebaceous glands, sweat glands, or facial hair.

<span class="mw-page-title-main">Adenoma sebaceum</span> Medical condition

Adenoma sebaceum, also known as facial angiofibroma is a misnamed cutaneous disorder consisting of angiofibromas that begin in childhood and appear clinically as red papules on the face especially on the nasolabial folds, cheek and chin, often misidentified as acne not responding to treatment. Adenoma sebaceum may at times be associated with tuberous sclerosis. Gradually the papules become more prominent with time and persist throughout life. Cosmetic removal by argon or pulse dye laser or scalpel is indicated.

<span class="mw-page-title-main">John Addison Fordyce</span> American dermatologist

John Addison Fordyce was an American professor of dermatology whose name is associated with Fordyce's spot, angiokeratoma of Fordyce, Brooke–Fordyce trichoepithelioma, and Fox–Fordyce disease.

<span class="mw-page-title-main">Balanitis plasmacellularis</span> Medical condition

Balanitis plasmacellularis, also known as balanitis circumscripta plasmacellularis, Zoon balanitis, or plasma cell balanitis, is a cutaneous condition characterized by a benign inflammatory skin lesion characterized histologically by a plasma cell infiltrate.

<span class="mw-page-title-main">Sebaceous adenoma</span> Medical condition

Sebaceous adenomais a type of adenoma, characterized by a slow-growing tumor usually presenting as a pink, flesh-coloured, or yellow papule or nodule.

Oral pigmentation is asymptomatic and does not usually cause any alteration to the texture or thickness of the affected area. The colour can be uniform or speckled and can appear solitary or as multiple lesions. Depending on the site, depth, and quantity of pigment, the appearance can vary considerably.

Vestibular papillomatosis (VP) are normal small bumps in the genital area of females. The bumps appear in multiple numbers, are rounded and are not painful, itchy or uncomfortable. They are comparable to pearly penile papules, which occur in males.

References

  1. 1 2 3 "Fordyce spots: Quick and Informative guidance — DermNet". dermnetnz.org. Retrieved 27 April 2023.
  2. James WD, Elston D, Treat JR, Rosenbach MA, Neuhaus I (2020). "34. Disorders of the mucous membranes". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. p. 798. ISBN   978-0-323-54753-6.
  3. 1 2 3 4 5 6 Hall A (2019). "7. Ectopic sebaceous glands". Atlas of Male Genital Dermatology. Springer. pp. 15–18. ISBN   978-3-319-99749-0.
  4. Crissey JT, Parish LC, Holubar K (2013). Historical Atlas of Dermatology and Dermatologists. CRC Press. p. 87. ISBN   978-1-84184-864-8.
  5. Fordyce first described them in 1896. synd/1510 at Who Named It?
  6. derm/395 at eMedicine
  7. Khoo LS, Cheong WK (July 1995). "Common genital dermatoses in male patients attending a public sexually transmitted disease clinic aka(DC) in Singapore". Annals of the Academy of Medicine, Singapore. 24 (4): 505–9. PMID   8849177.
  8. 1 2 3 4 Rane V, Read T (May 2013). "Penile appearance, lumps and bumps". Australian Family Physician. 42 (5): 270–4. PMID   23781523.
  9. Palo Alto Medical Foundation Bettina McAdoo, M.D. Retrieved June 24, 2006.
  10. 1 2 3 4 5 6 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.
  11. "Fordyce spots". DermNet NZ (in Afrikaans). Retrieved 2019-12-21. The importance of recognising these papules as Fordyce spots is in the differential diagnosis of other conditions that may appear similar. Some sexually transmitted diseases (STDs) may start off looking like Fordyce spots on the genitals so it is essential to get a proper diagnosis from your doctor. STDs need to be treated appropriately with medication.
  12. "Fordyce Spots: Symptoms, Causes, Treatment & On Lips". Cleveland Clinic. Retrieved 2024-01-02.