Fordyce spots

Fordyce spots
Other names: Fordyce granules
Fordyce granules inside of cheek
Specialty	Dermatology
Symptoms	Painless white-yellow small bumps or spots in mouth or genitalia[1]
Usual onset	Puberty[1]
Causes	Unknown[2]
Diagnostic method	Visualisation[2]
Differential diagnosis	Genital warts, molluscum[2]
Frequency	Common[2]

Fordyce spots are painless white-yellow small bumps or spots on the inside of the lips or cheeks, gums, or genitalia.^[1][3] They are a normal sebaceous glands not associated with hair follicles.^[2] There may be just one or a group of many.^[1] Their appearance may cause psychological distress in some.^[2]

The cause is unclear.^[2] Diagnosis is based on their appearance.^[2] Other conditions that may appear similar include genital warts and molluscum.^[2]

Treatment is not required, beyond reassurance.^[2] Attempts to remove them typically result in pain and scarring.^[2] The spots are harmless.^[2]

Fordyce spots are common and are present in around 80% of adults.^[1] They are present in around 65% of uncircumcised males; typically on the inner side of the foreskin and occasionally on the glans.^[2] They were first described in 1896 by American dermatologist John Addison Fordyce, who mistook them for a skin disease.^[4]

Classification

Sebaceous glands are normal structures of the skin but may also be found ectopically in the mouth.^[2]

On the foreskin they are called Tyson's glands,^[5] not to be confused with hirsuties coronae glandis.^[6]

When they appear on the penis, they are also called penile sebaceous glands.^[7]

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. Persons with this condition sometimes consult a dermatologist because they are worried they may have a sexually transmitted disease (especially genital warts) or some form of cancer.^[8]

On the shaft of the penis, Fordyce spots are more visible when the skin is stretched, and may only be noticeable during an erection.^[7] The spots can also appear on the skin of the scrotum.^[7]

Around the mouth 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,^[9] 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. Sebaceous carcinoma of the oral cavity has been reported, presumably arising from Fordyce granules or hyperplastic foci of sebaceous glands.

In some people, the glands express a thick, chalky discharge when squeezed.^[7]

Causes

They appear to be more obvious in people with oily skin types, with some rheumatic disorders, and in hereditary nonpolyposis colorectal cancer.^[9] In the latter, the most common site for Fordyce spots is the lower gingiva (gums) and vestibular mucosa.^[9]

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.

Treatment

Most doctors consider this a normal physiological phenomenon and advise against treatment.^[11]

Prognosis

Fordyce spots are completely benign^[9] and require no treatment. They occur in 70 to 80 percent of adults. Often their presence is considered normal anatomic variance rather than a true medical condition.

Epidemiology

It is 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.^[9] They are more prominent in males.^[9]

History

They are named after the American dermatologist, John Addison Fordyce.^[12]

References