What are Fordyce spots?
Fordyce spot, otherwise known as “fordyce granule”, is a fairly common, non-infectious condition that affects the skin of the genital area as well as the face. uncommon locations are the buccal mucosa as well as the esophagus. Moreover, fordyce spots are considered to be natural-occuring and does not pose a great risk to the patient’s overall health condition.
Fordyce spots have no known gender preference; meaning, it can affect both men and women, with no significant difference in prevalence rates. it has no known age partiality too. It can occur throughout an individual’s life span and there are no known associations or relationship with any illness or disease. However, older individuals show more visible and frequent spots than those younger ones.
Additionally, people only tend to seek medical attention due to fear of getting infected with sexually transmitted disease since the sports are mostly located in the genital area.
Causes of Fordyce spots
In normal physiology, sebacious glands or the oil-producing glands of the body are more often than not, associated with hair follicles; however, in this specific case, fordyce spot arises as a variety of an ectopic sebacious gland. This means that a fordyce spot may be elucidated as an atypical sebaceous gland with no hair follicle.
Normal sebacious glands produce oil or sebum in the body and this oil needs to be excreted, otherwise, problems may arise. Normally, the sebacious gland excretes the oil through the hair follicle leading ultimately into the hair shaft. However, in the case of fordyce spot, there is no presence of hair follicles, thereby rendering the oil trapped in the sebacious glands. These trapped oils then cause overgrowth of the sebacious glands or the bumps found in fordyce spots.
Lastly, there have been reports that have established links of hormonal influences and puberty per se as plausible causes of the occurrence of fordyce spots.
In another note, the specific etiology or cause of fordyce spots specifically found in moist areas such as the oral mucosa has not yet been clearly elucidated; although there are claims of its genetic origin but is still not yet fully proven.
Symptoms of Fordyce spots
Fordyce spots are minute, elevated spots or bumps found in the genital area, be it along the shaft of the penis, the scrotum and on the labia for the females; although, these spots are specifically referred to as Tyson’s glands if they are found at the head of the penis. However, these spots are not limited to the genital area alone. It can also be found in the face, specifically in the retromolar mucosa or the inner surface of the lips, as well as along the vermilion border or the area where the lips and the adjacent skin meet.
Furthermore, fordyce spots are usually painless in nature and are asymptomatic, unless of course, if it is inappropriately managed. The spots are additionally non-pruritic. Their color ranges from being pale or white to reddish spots and its overall diameter ranges from one to three mm. In addition, these spots are usually seen in clusters of 50 to 100 spots rather than isolated ones.
Diagnostic Tests and Differential Diagnosis
Diagnosis of fordyce spots may be done through thorough physical examination by use of ocular observation. The medical professional should note the specific clinical manifestations as stated above. However, biopsy may be necessary should the need of it arise.
In addition, due to the fact that fordyce spots do resemble various conditions, differential diagnosis should also be done. Similar conditions that should be ruled out through differential diagnosis are as follows:
- angiokeratoma of fordyce otherwise known as angiokeratoma of the vulva and scrotum,
- hirsuties papillaries genitalis,
- fibrous papule of the face,
- follicular infundibulum tumor,
- sebaceous adenoma,
- sebaceous carcinoma; and,
- a number of sexually transmitted diseases among others
Treatment for Fordyce spots
Fordyce spots are natural physiologic occurrence and are usually self-limiting; meaning, it will resolve on its own. That is why medical treatments may not be necessary. In fact, there are no known routine medications or surgical intervention specific for the condition. However, if it does bother the patient then various medical treatments are available to fade out its presence. A number of methods of treatment will be discussed below:
Fordyce spots may be managed by employing medical technologies such as several vaporising laser treatments. Example of a laser treatment is electro desiccation otherwise known as CO? laser. This method has, in so far, shown positive results. However, further studies show that the use of CO? along with topical bichloracetic acid or trichloracetic acid (discussed in detail in a separate section below) has also shown better results and all the better, showed no recurence of the bumps.
Another more sophisticated laser management would be the utilization of pulse dye lasers. Although, this mode of treatment is higher in cost than electro dessication, it has considerably shown to be more effective. Moreover, pulse dye laser leaves no scar after the procedure.
There are also pharmacologic methods of treatment available for patients who opt to use medical aid in the resolution of fordyce spots. One of which is a chemical peel called trichloroacetic acid. This trichloroacetic acid causes flaking of the skin, which then consequently peels off the skin in the bump, thereby significantly reducing its prominence. However, caution should be practiced when applying such chemical peel in fordyce spots located in the lips as this may cause increased sensitivity in the area. Thus, application of constant moisturizers may be recommended. The fordyce spots, however, can recur or reappear once treatment is stopped.
Another pharmacologic approach that may be recommended is the administration of tretinoin cream or gel. This tretinion cream has shown positive results in diminishing the prominence of fordyce spots and may also keep it from spreading all over the body; however, tretinoins should not be used for an extended period of time.
Lastly, the use of accutane has also been recommended. However, accutane does pose a number of undesirable side effects such as renal problems, headace, nausea, dry skin as well as skin rashes, muscle pain and vision problems among others. Due to this extensive list of side effects, it is vital that the patient consult a physician before popping this drug into the system.
Although rarely advised, there is an available surgical intervention for the removal of fordyce spots and this is what we call, cryotherapy. Cryotherapy is done with the use of a cryoprobe – a tremendously arctic material to excise or destroy the bumps. The procedure is non-invasive and surrounding healthy skin may be slightly damaged but is not a major cause of concern as this may heal in a few days time.
Reports of the use of 5-aminolevulinic acid photodynamic therapy in reducing fordyce spots have also shown positive results however a number of undesirable side effects have been documented such as hyperpigmentation, vesiculation, and burning sensation.
In a commonly misconceived case like fordyce spots, patient awareness is vital for its proper management. The patient should be counselled that these spots are of no major health concern and is naturally occurring.
Patient should also be advised to practice good personal hygiene to prevent aggravation of the condition. Moreover, the patient should be advised to avoid, at all cost, the squeezing, scratching, picking and other means to put pressure on the bumps as this may cause unnecessary complications.
Last but not the least; make sure to counsel the patient to consult with a physician first before taking any forms of medications as this may only pose greater problems. Always remember to avoid self-medication.
Well balanced diet
A well balanced diet may also help in the fast reduction of these spots, especially a diet rich in vitamins and minerals such as vitamins A, B, C, D, E and K.
Lastly, incorporation or inclusion of garlic in the diet has also shown positive results, since garlic is rich in folic acid and may also have natural antibiotic effects on the body, thereby reducing risks for infection (although rare).
Fordyce spot is a natural physiologic occurrence of the body and is more often than not, self-limiting in nature, even without medical treatment.
Fordyce Spots Pictures
Picture 1 :Fordyce Spots
Picture 2 : Fordyce Spots photo
Image source : dermatlas.med.jhmi.edu
Picture 3 : Fordyce Spots in upper lip
Image source : atlasdermatologico.com