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

Normally, sebaceous glands are only found in association with a hair follicle.[ citation needed ]

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 on the face. Newly formed nodules often swell with sweating, but this diminishes over time.

<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 nipple, areolar glands are specialized sebaceous glands for lubricating the nipple. 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">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">Perioral dermatitis</span> Medical condition

Perioral dermatitis, also known as periorificial dermatitis, is a common type of skin rash. Symptoms include multiple small (1–2 mm) bumps and blisters sometimes with background redness and scale, localized to the skin around the mouth and nostrils. Less commonly the eyes and genitalia may be involved. It can be persistent or recurring and resembles particularly rosacea and to some extent acne and allergic dermatitis. The term "dermatitis" is a misnomer because this is not an eczematous process.

<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.

Fox–Fordyce disease is a chronic blockage of the sweat gland ducts with a secondary, non-bacterial inflammatory response to the secretions and cellular debris in the cysts. The inflammation is often accompanied by intense itching. In general, the disease often causes skin to darken near the affected area and raised bumps or papules to appear. In addition, hair follicles can become damaged which cause hair loss. Hidradenitis is very similar, but tends to have a secondary bacterial infection so that pus-draining sinuses are formed. It is a very devastating skin disease that does not have universally curative treatments.

<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">Trichilemmal cyst</span> Common cyst that forms from a hair follicle

A trichilemmal cyst is a common cyst that forms from a hair follicle, most often on the scalp, and is smooth, mobile, and filled with keratin, a protein component found in hair, nails, skin, and horns. Trichilemmal cysts are clinically and histologically distinct from trichilemmal horns, hard tissue that is much rarer and not limited to the scalp. Rarely, these cysts may grow more extensively and form rapidly multiplying trichilemmal tumors, also called proliferating trichilemmal cysts, which are benign, but may grow aggressively at the cyst site. Very rarely, trichilemmal cysts can become cancerous.

Scarring hair loss, also known as cicatricial alopecia, is the loss of hair which is accompanied with scarring. This is in contrast to non scarring hair loss.

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

Sebaceous carcinoma, also known as sebaceous gland carcinoma (SGc), sebaceous cell carcinoma, and meibomian gland carcinoma is an uncommon malignant cutaneous tumor. Most are typically about 1.4 cm at presentation. SGc originates from sebaceous glands in the skin and, therefore, may originate anywhere in the body where these glands are found. SGc can be divided into 2 types: periocular and extraocular. The periocular region is rich in sebaceous glands making it a common site of origin. The cause of these lesions in the vast majority of cases is unknown. Occasional cases may be associated with Muir-Torre syndrome. SGc accounts for approximately 0.7% of all skin cancers, and the incidence of SGc is highest in Caucasian, Asian, and Indian populations. Due to the rarity of this tumor and variability in clinical and histological presentation, SGc is often misdiagnosed as an inflammatory condition or a more common neoplasm. SGc is commonly treated with wide local excision or Mohs micrographic surgery, and the relative survival rates at 5 and 10 years are 92.72 and 86.98%, respectively.

<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.

Infantile acne is a form of acne that begins in very young children. Typical symptoms include inflammatory and noninflammatory lesions, papules and pustules most commonly present on the face. No cause of infantile acne has been established but it may be caused by increased sebaceous gland secretions due to elevated androgens, genetics and the fetal adrenal gland causing increased sebum production. Infantile acne can resolve by itself by age 1 or 2. However, treatment options include topical benzyl peroxide, topical retinoids and topical antibiotics in most cases.

<span class="mw-page-title-main">Sebaceous adenitis</span> Skin disease

Sebaceous adenitis in an uncommon skin disease found in some breeds of dog, and more rarely in cats, rabbits and horses. characterised by an inflammatory response against the dog's sebaceous glands, which can lead to the destruction of the gland. It was first described in veterinary literature in the 1980s.

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.